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Xu F, Meng L, Lin H, Xu W, Guo H, Peng F. Systematic review of leadless pacemaker. Acta Cardiol 2024; 79:284-294. [PMID: 37961771 DOI: 10.1080/00015385.2023.2276537] [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: 05/24/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
Conventional pacing systems consist of a pacemaker and one or more leads threaded from the device pocket through veins into the heart conducting the pacing therapy to the desired pacing site. Although these devices are effective, approximately one in eight patients treated with these traditional pacing systems experiences a complication attributed to the pacemaker pocket or leads. With the technological advances in electronics, leadless pacemakers that small enough to implant within the heart were introduced. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing including complications related to leads or pacemaker pockets. This review aims to provide an overview of advantages of leadless pacemaker, complications and limitations of leadless pacemaker, leadless pacemaker candidate, and future directions of this promising technology.
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Affiliation(s)
- Fukang Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Liping Meng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hui Lin
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiyuan Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hangyuan Guo
- Shaoxing Wen li Medical College, Shaoxing, China
| | - Fang Peng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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2
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Verma Y, Arachchige ASPM. Revolutionizing cardiovascular care: the power of histotripsy. J Ultrasound 2024:10.1007/s40477-023-00848-7. [PMID: 38217765 DOI: 10.1007/s40477-023-00848-7] [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: 09/28/2023] [Accepted: 11/13/2023] [Indexed: 01/15/2024] Open
Abstract
Histotripsy, an innovative ultrasonic technique, is poised to transform the landscape of cardiovascular disease management. This review explores the multifaceted applications of histotripsy across various domains of cardiovascular medicine. In thrombolysis, histotripsy presents a non-invasive, drug-free, and precise method for recanalizing blood vessels obstructed by clots, minimizing the risk of vessel damage and embolism. Additionally, histotripsy showcases its potential in congenital heart defect management, offering a promising alternative to invasive procedures by creating intracardiac communications noninvasively. For patients with calcified aortic stenosis, histotripsy demonstrates its effectiveness in softening calcified bioprosthetic valves, potentially revolutionizing valve interventions. In the realm of arrhythmias, histotripsy could play an important role in scar-based ventricular tachycardia ablation, eliminating channel-like isthmuses of slowly conducting myocardium. Histotripsy`s potential applications also extend to structural heart interventions, enabling the safe sectioning of basal chordae and potentially addressing mitral regurgitation. Furthermore, it showcases its versatility by safely generating ventricular septal defects, providing a non-invasive means of creating intracardiac communications in neonates with congenital heart disease. Yet, most supporting studies are in-vitro or animal studies and there are possible challenges in translating experimental data on cardiac histotripsy to the clinical level. As histotripsy continues to evolve and mature, its remarkable potential in cardiovascular disease management holds promise for improving patient outcomes and reducing the burden of invasive procedures in the field of cardiology.
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Affiliation(s)
- Yash Verma
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Ibrahim R, Khoury A, El-Chami MF. Leadless Pacing: Where We Currently Stand and What the Future Holds. Curr Cardiol Rep 2022; 24:1233-1240. [PMID: 35951261 DOI: 10.1007/s11886-022-01752-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Leadless pacemakers (LPs) are emerging as alternative cardiac implantable devices for the treatment of bradyarrhythmia. This article aims to review the data behind the safety and efficacy of these devices while highlighting their pros and cons. RECENT FINDINGS Prospective non-randomized studies and registries have found that LPs are associated with lower rate of device-related complications mainly driven by lower need for lead-related interventions as compared to traditional pacemakers. On the other hand, cardiac perforation appears to occur more frequently with LPs. LPs are associated with lower rate of device-related complications as compared to the traditional pacemakers. However, the rate of pericardial effusion is higher and is more severe. As we transition to multi-chamber LPs, it is important to ensure the safety and efficacy of these devices.
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Affiliation(s)
- Rand Ibrahim
- Department of Medicine, Division of Cardiology-Emory University School of Medicine, 12thFloor Medical Office Tower, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Alexandre Khoury
- Universite St Joseph School of Medicine-Beirut Lebanon, Beirut, Lebanon
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology-Emory University School of Medicine, 12thFloor Medical Office Tower, 550 Peachtree Street NE, Atlanta, GA, 30308, USA.
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4
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Allam C. Acoustic energy and cardiac electrophysiology: Ultrasonic cardiac pacing and novel shockwave ablation catheters. Pacing Clin Electrophysiol 2022; 45:800-806. [DOI: 10.1111/pace.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Chadi Allam
- Faculty of Medicine Saint‐Joseph University Beirut Lebanon
- Department of Cardiology Hôtel‐Dieu de France Hospital Beirut Lebanon
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5
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Anwar U, Ajijola OA, Shivkumar K, Markovic D. Towards a Leadless Wirelessly Controlled Intravenous Cardiac Pacemaker. IEEE Trans Biomed Eng 2022; 69:3074-3086. [PMID: 35320081 DOI: 10.1109/tbme.2022.3161415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Traditional lead-based cardiac pacemakers suffer from lead-related complications including lead fracture, lead dislodgement, and venous obstruction. Modern leadless pacemakers mitigate the complications, but since they are implanted inside the heart with a small battery, their limited battery lifetime necessities device replacement within the patient's lifetime. This paper presents a leadless and batteryless, wirelessly powered intravenous cardiac pacemaker that can potentially mitigate both problems. METHODS Wireless power is transferred at 13.56 MHz in bursts between the pacemaker modules to achieve sufficient power over the required distance for wireless pacing. The pacemaker stimulation module is designed to fit within the anatomical constraints of a cardiac vein, consume low power, apply greater than 5V stimulation and comply with FCC SAR regulations. The module is primarily implemented in CMOS technology to achieve extreme system miniaturization. RESULTS Ex-vivo pacing capability was demonstrated with a system that can apply 5V stimulation, consume 1mW power, and operate up to 2.5cm TX and RX separation. An in-vivo experiment verified the pacemaker functionality by increasing the heartbeat of Yorkshire pig from 64bpm to 100bpm. CONCLUSION This work establishes that intravascular cardiac pacing can be achieved that can mitigate lead and battery-related complications. SIGNIFICANCE This study has a potential to advance leadless and wirelessly powered pacemaker technology.
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Cang J, Liu Y, Zhu D, Liu S, Shen J, Miao H, Zhou Q, Chen L. WiSE CRT Is Beneficial for Heart Failure Patients as a Rescue Therapy: Evidence From a Meta-Analysis. Front Cardiovasc Med 2022; 9:823797. [PMID: 35369306 PMCID: PMC8964787 DOI: 10.3389/fcvm.2022.823797] [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: 11/28/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLeadless endocardial left ventricular (LV) pacing resynchronization therapy is a novel solution for patients with heart failure (HF) in whom conventional cardiac resynchronization therapy (CRT) failed.MethodsPubMed and the Cochrane Library were searched for relevant cohort studies. Clinical outcomes of interest such as ejection fraction (EF), QRS duration (QRSd), and left ventricular end-systolic volume (LVESV) were extracted and analyzed.ResultsFive studies involving 175 HF patients for WiSE CRT were included, and patients were followed-up for 6 months. The implanted success rate ranged from 76.5 to 100%. WiSE CRT resulted in significantly narrower QRSd [mean difference (MD): −38.21 ms, 95% confidence interval (CI): −44.36 to −32.07, p < 0.001], improved left ventricular ejection fraction (MD: 6.07%, 95% CI: 4.43 to 7.71, I2 = 0%, p < 0.001), reduced left ventricular end-systolic volume (MD: −23.47 ml, 95% CI: −37.18 to −9.13, p < 0.001), and reduced left ventricular end-diastolic volume (MD: −24.02 ml, 95% CI: −37.01 to −11.03, p = 0.02).ConclusionEvidence from current studies suggests that leadless endocardial LV pacing resynchronization is effective for HF patients who failed conventional CRT or needed a device upgrade, and it may be an interesting rescue therapy.
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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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Yang SY, Sencadas V, You SS, Jia NZX, Srinivasan SS, Huang HW, Ahmed AE, Liang JY, Traverso G. Powering Implantable and Ingestible Electronics. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2009289. [PMID: 34720792 PMCID: PMC8553224 DOI: 10.1002/adfm.202009289] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 05/28/2023]
Abstract
Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.
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Affiliation(s)
- So-Yoon Yang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vitor Sencadas
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; School of Mechanical, Materials & Mechatronics Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Siheng Sean You
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Neil Zi-Xun Jia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Shriya Sruthi Srinivasan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hen-Wei Huang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abdelsalam Elrefaey Ahmed
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jia Ying Liang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Turner BL, Senevirathne S, Kilgour K, McArt D, Biggs M, Menegatti S, Daniele MA. Ultrasound-Powered Implants: A Critical Review of Piezoelectric Material Selection and Applications. Adv Healthc Mater 2021; 10:e2100986. [PMID: 34235886 DOI: 10.1002/adhm.202100986] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Indexed: 12/14/2022]
Abstract
Ultrasound-powered implants (UPIs) represent cutting edge power sources for implantable medical devices (IMDs), as their powering strategy allows for extended functional lifetime, decreased size, increased implant depth, and improved biocompatibility. IMDs are limited by their reliance on batteries. While batteries proved a stable power supply, batteries feature relatively large sizes, limited life spans, and toxic material compositions. Accordingly, energy harvesting and wireless power transfer (WPT) strategies are attracting increasing attention by researchers as alternative reliable power sources. Piezoelectric energy scavenging has shown promise for low power applications. However, energy scavenging devices need be located near sources of movement, and the power stream may suffer from occasional interruptions. WPT overcomes such challenges by more stable, on-demand power to IMDs. Among the various forms of WPT, ultrasound powering offers distinct advantages such as low tissue-mediated attenuation, a higher approved safe dose (720 mW cm-2 ), and improved efficiency at smaller device sizes. This study presents and discusses the state-of-the-art in UPIs by reviewing piezoelectric materials and harvesting devices including lead-based inorganic, lead-free inorganic, and organic polymers. A comparative discussion is also presented of the functional material properties, architecture, and performance metrics, together with an overview of the applications where UPIs are being deployed.
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Affiliation(s)
- Brendan L. Turner
- Joint Department of Biomedical Engineering North Carolina State University and University of North Carolina Chapel Hill, 911 Oval Dr. Raleigh NC 27695 USA
| | - Seedevi Senevirathne
- The Patrick G Johnston Centre for Cancer Research Queen's University 97 Lisburn Rd Belfast BT9 7AE UK
| | - Katie Kilgour
- Department of Chemical and Biomolecular Engineering North Carolina State University Raleigh NC 27695 USA
| | - Darragh McArt
- The Patrick G Johnston Centre for Cancer Research Queen's University 97 Lisburn Rd Belfast BT9 7AE UK
| | - Manus Biggs
- Centre for Research in Medical Devices National University of Ireland Newcastle Road Galway H91 W2TY Ireland
| | - Stefano Menegatti
- Department of Chemical and Biomolecular Engineering North Carolina State University Raleigh NC 27695 USA
| | - Michael A. Daniele
- Joint Department of Biomedical Engineering North Carolina State University and University of North Carolina Chapel Hill, 911 Oval Dr. Raleigh NC 27695 USA
- Department of Electrical and Computer Engineering North Carolina State University 890 Oval Dr. Raleigh NC 27695 USA
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10
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Singer A, Robinson JT. Wireless Power Delivery Techniques for Miniature Implantable Bioelectronics. Adv Healthc Mater 2021; 10:e2100664. [PMID: 34114368 PMCID: PMC8754427 DOI: 10.1002/adhm.202100664] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/11/2021] [Indexed: 12/14/2022]
Abstract
Progress in implanted bioelectronic technology offers the opportunity to develop more effective tools for personalized electronic medicine. While there are numerous clinical and pre-clinical applications for these devices, power delivery to these systems can be challenging. Wireless battery-free devices offer advantages such as a smaller and lighter device footprint and reduced failures and infections by eliminating lead wires. However, with the development of wireless technologies, there are fundamental tradeoffs between five essential factors: power, miniaturization, depth, alignment tolerance, and transmitter distance, while still allowing devices to work within safety limits. These tradeoffs mean that multiple forms of wireless power transfer are necessary for different devices to best meet the needs for a given biological target. Here six different types of wireless power transfer technologies used in bioelectronic implants-inductive coupling, radio frequency, mid-field, ultrasound, magnetoelectrics, and light-are reviewed in context of the five tradeoffs listed above. This core group of wireless power modalities is then used to suggest possible future bioelectronic technologies and their biological applications.
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Affiliation(s)
- Amanda Singer
- Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX, 77005, USA
| | - Jacob T Robinson
- Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX, 77005, USA
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11
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Okabe T, Hummel JD, Bank AJ, Niazi IK, McGrew FA, Kindsvater S, Oza SR, Scherschel JA, Walsh MN, Singh JP. Leadless left ventricular stimulation with WiSE-CRT System - Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase). Heart Rhythm 2021; 19:22-29. [PMID: 34332966 DOI: 10.1016/j.hrthm.2021.06.1195] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resynchronization therapy (CRT). WiSE-CRT is a wireless LV endocardial pacing system, and delivers ultrasonic energy to an LV electrode. OBJECTIVE The purpose of this study was to present short-term outcomes with the WiSE-CRT system in centers with no prior implanting experience. METHODS Data were prospectively collected from 19 centers where WiSE-CRT systems were implanted during the roll-in phase of the SOLVE-CRT trial. Patients were followed at 1, 3, and 6 months, including transthoracic echo (TTE) at 6 months. RESULTS The WiSE-CRT was successfully implanted in all 31 attempted cases, and 30 patients completed the 6-month follow-up. One patient underwent heart transplantation 1 month after implantation, and was excluded. Fourteen (46.7%) patients demonstrated ≥1 NYHA class improvement. TTE data were available in 29 patients. LV ejection fraction, LV end-systolic volume, and LV end-diastolic volume improved from 28.3% ± 6.7% to 33.5% ± 6.9% (P < .001), 134.9 ± 51.3 mL to 111.1 ± 40.3 mL (P = .0004), and 185.4 ± 58.8 mL to 164.9 ± 50.6 mL (P = .0017), respectively. There were 3 (9.7%) device-related type 1 complications: 1 insufficient LV pacing, 1 embolization of an unanchored LV electrode, and 1 skin infection. CONCLUSIONS We demonstrated a high success rate of LV endocardial electrode placement in centers with no prior implanting experience. Favorable clinical responses in heart failure symptoms and significant LV reverse remodeling were noted.
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Affiliation(s)
- Toshimasa Okabe
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - John D Hummel
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alan J Bank
- Minneapolis Heart Institute, Allina Health, St. Paul, Minnesota
| | | | | | | | - Saumil R Oza
- Ascension St. Vincent's Hospital, Jacksonville, Florida
| | | | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [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: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
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13
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Left ventricle pacing challenges in cardiac resynchronization therapy systems. Indian Pacing Electrophysiol J 2021; 21:232-240. [PMID: 33862228 PMCID: PMC8263312 DOI: 10.1016/j.ipej.2021.04.001] [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: 01/23/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022] Open
Abstract
Left ventricle (LV) pacing can be considered peculiar due to its different lead/tissue interface (epicardial pacing) and the small vein wedging lead locations with less reliable lead stability. The current technologies available for LV capture automatic confirmation adopt the evoked response (ER), as well as "LV pace to right ventricular (RV) sense" algorithms. The occurrence of anodal RV capture is today completely solved by the use of bipolar LV leads, while intriguing data are recently published regarding the unintentional LV anodal capture beside the cathodal one, which may enlarge the front wave of cardiac resynchronization therapy (CRT) delivery. The LV threshold behavior over time leading to ineffective CRT issues (subthreshold stimulation or concealed loss of capture), the extracardiac capture with phrenic nerve stimulation (PNS), the flexible electronic cathode reprogramming and the inadequate CRT delivery related to inadequate AV and VV pace timing (and its management by LV "dromotropic pace-conditioning") are discussed. Moreover, recently, His bundle pacing (HBP) and left bundle branch pacing (LBBP) have shown growing interest to prevent pacing-induced cardiomyopathy as well as for direct intentional CRT. The purpose of the present review is to explore these new challenges regarding LV pacing starting from old concepts.
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14
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Abiri P, Duarte-Vogel S, Chou TC, Abiri A, Gudapati V, Yousefi A, Roustaei M, Chang CC, Cui Q, Hsu JJ, Bersohn M, Markovic D, Chen J, Tai YC, Hsiai TK. In Vivo Intravascular Pacing Using a Wireless Microscale Stimulator. Ann Biomed Eng 2021; 49:2094-2102. [PMID: 33537925 DOI: 10.1007/s10439-021-02729-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
Millions of patients worldwide are implanted with permanent pacemakers for the treatment of cardiac arrhythmias and conduction disorders. The increased use of these devices has established a growing clinical need to mitigate associated complications. Pacemaker leads, in particular, present the primary risks in most implants. While wireless power transfer holds great promise in eliminating implantable device leads, anatomical constraints limit efficient wireless transmission over the necessary operational range. We thereby developed a transmitter-centered control system for wireless power transfer with sufficient power for continuous cardiac pacing. Device safety was validated using a computational model of the system within an MRI-based anatomical model. The pacer was then fabricated to meet the acute constraints of the anterior cardiac vein (ACV) to enable intravascular deployment while maintaining power efficiency. Our computational model revealed the wireless system to operate at > 50 times below the tissue energy absorption safety criteria. We further demonstrated the capacity for ex vivo pacing of pig hearts at 60 beats per minute (BPM) and in vivo pacing at 120 BPM following pacer deployment in the ACV. This work thus established the capacity for wireless intravascular pacing with the potential to eliminate complications associated with current lead-based deep tissue implants.
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Affiliation(s)
- Parinaz Abiri
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Sandra Duarte-Vogel
- Division of Laboratory Animal Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tzu-Chieh Chou
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Arash Abiri
- School of Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Varun Gudapati
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alireza Yousefi
- Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Mehrdad Roustaei
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Chih-Chiang Chang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Qingyu Cui
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jeffrey J Hsu
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Malcolm Bersohn
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Dejan Markovic
- Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Yu-Chong Tai
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Tzung K Hsiai
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA.
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15
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Abiri P, Yousefi A, Abiri A, Gudapati V, Ding Y, Nguyen KL, Abiri A, Markovic D, Tai YC, Hsiai TK. A Multi-Dimensional Analysis of a Novel Approach for Wireless Stimulation. IEEE Trans Biomed Eng 2020; 67:3307-3316. [PMID: 32248088 DOI: 10.1109/tbme.2020.2983443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The elimination of integrated batteries in biomedical implants holds great promise for improving health outcomes in patients with implantable devices. However, despite extensive research in wireless power transfer, achieving efficient power transfer and effective operational range have remained a hindering challenge within anatomical constraints. OBJECTIVE We hereby demonstrate an intravascular wireless and batteryless microscale stimulator, designed for (1) low power dissipation via intermittent transmission and (2) reduced fixation mechanical burden via deployment to the anterior cardiac vein (ACV, ∼3.8 mm in diameter). METHODS We introduced a unique coil design circumferentially confined to a 3 mm diameter hollow-cylinder that was driven by a novel transmitter-based control architecture with improved power efficiency. RESULTS We examined wireless capacity using heterogenous bovine tissue, demonstrating >5 V stimulation threshold with up to 20 mm transmitter-receiver displacement and 20° of misalignment. Feasibility for human use was validated using Finite Element Method (FEM) simulation of the cardiac cycle, guided by pacer phantom-integrated Magnetic Resonance Images (MRI). CONCLUSION This system design thus enabled sufficient wireless power transfer in the face of extensive stimulator miniaturization. SIGNIFICANCE Our successful feasibility studies demonstrated the capacity for minimally invasive deployment and low-risk fixation.
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16
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Hai JJ, Chan YH, Lau CP, Tse HF. Single-chamber leadless pacemaker for atrial synchronous or ventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1438-1450. [PMID: 33089883 DOI: 10.1111/pace.14105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/21/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
Abstract
Leadless pacing is a major breakthrough in the management of bradyarrhythmia. Results of initial clinical trials that have demonstrated a significant reduction in acute and long-term pacing-related complications have been confirmed by real-world experience in a broader spectrum of patients. Nonetheless current use of a leadless pacemaker is hampered by its limited atrial sensing and pacing capability, as well as battery life-span and retrievability. We review the current clinical outcome data, indications and contraindications, implantation and retrieval techniques, synchronous ventricular pacing, and other clinical considerations. We also provide an overview of the latest advancements in leadless pacing technology including device-to-device communication and energy harvesting technology.
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Affiliation(s)
- Jo-Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.,Division of Cardiology, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Yap-Hang Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.,Shenzhen Institute of Research and Innovation, University of Hong Kong, Shenzhen, China
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17
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Implantable cardioverter defibrillators - the past, present and future. ACTA ACUST UNITED AC 2020; 5:e163-e170. [PMID: 32832716 PMCID: PMC7433784 DOI: 10.5114/amsad.2020.97103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 11/17/2022]
Abstract
Since their formal introduction in 1980, implantable cardioverter defibrillators (ICDs) have undergone innumerable design modifications through several generations. They are indispensable today in successfully managing fatal ventricular arrhythmias. Their role in averting sudden cardiac death is recognized beyond doubt. Their applications and indications have continuously expanded over the last two decades. This article reviews the salient features in the evolution of ICDs, their current indications, recent advances and future directions. With more advanced detection algorithms, the potential integration with leadless pacing, and the possibility to serve as a remote monitoring device to recognize atrial fibrillation, acute ischemia, or electrolyte imbalance, the application of ICDs is rapidly evolving.
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18
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Sieniewicz BJ, Betts TR, James S, Turley A, Butter C, Seifert M, Boersma LVA, Riahi S, Neuzil P, Biffi M, Diemberger I, Vergara P, Arnold M, Keane DT, Defaye P, Deharo JC, Chow A, Schilling R, Behar J, Rinaldi CA. Real-world experience of leadless left ventricular endocardial cardiac resynchronization therapy: A multicenter international registry of the WiSE-CRT pacing system. Heart Rhythm 2020; 17:1291-1297. [PMID: 32165181 PMCID: PMC7397503 DOI: 10.1016/j.hrthm.2020.03.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/02/2020] [Indexed: 01/28/2023]
Abstract
Background Biventricular endocardial pacing (BiV ENDO) is a therapy for heart failure patients who cannot receive transvenous epicardial cardiac resynchronization therapy (CRT) or have not responded adequately to CRT. BiV ENDO CRT can be delivered by a new wireless LV ENDO pacing system (WiSE-CRT system; EBR Systems, Sunnyvale, CA), without the requirement for lifelong anticoagulation. Objective The purpose of this study was to assess the safety and efficacy of the WiSE-CRT system during real-world clinical use in an international registry. Methods Data were prospectively collected from 14 centers implanting the WiSE-CRT system as part of the WiCS-LV Post Market Surveillance Registry. (ClinicalTrials.gov Identifier: NCT02610673). Results Ninety patients from 14 European centers underwent implantation with the WiSE-CRT system. Patients were predominantly male, age 68.2 ± 10.5 years, left ventricular ejection fraction 30.6% ± 8.9%, mean QRS duration 180.7 ± 27.0 ms, and 40% with ischemic etiology. Successful implantation and delivery of BiV ENDO pacing was achieved in 94.4% of patients. Acute (<24 hours), 1- to 30-day, and 1- to 6-month complications rates were 4.4%, 18.8%, and 6.7%, respectively. Five deaths (5.6%) occurred within 6 months (3 procedure related). Seventy percent of patients had improvement in heart failure symptoms. Conclusion BiV ENDO pacing with the WiSE-CRT system seems to be technically feasible, with a high success rate. Three procedural deaths occurred during the study. Procedural complications mandate adequate operator training and implantation at centers with immediately available cardiothoracic and vascular surgical support.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom; Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Timothy R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Simon James
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Andrew Turley
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Christian Butter
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Martin Seifert
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Lucas V A Boersma
- St. Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands/AUMC, Amsterdam, Netherlands
| | - Sam Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | | | - Martin Arnold
- University Hospital Erlangen, Department of Cardiology, Erlangen, Germany
| | | | | | | | - Anthony Chow
- St. Bartholomew's Hospital, London, United Kingdom
| | | | | | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom; Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
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19
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Abiri P, Abiri A, Gudapati V, Chang CC, Roustaei M, Bourenane H, Anwar U, Markovic D, Hsiai TK. Wireless Pacing Using an Asynchronous Three-Tiered Inductive Power Transfer System. Ann Biomed Eng 2020; 48:1368-1381. [PMID: 31974869 DOI: 10.1007/s10439-020-02450-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Abstract
Despite numerous advancements in pacemaker technology for the treatment of cardiac arrhythmias and conduction disorders, lead-related complications associated with these devices continue to compromise patient safety and survival. In this work, we present a system architecture that has the capacity to deliver power to a wireless, batteryless intravascular pacer. This was made possible through a three-tiered, dual-sub-system, four-coil design, which operates on two different frequencies through intermittent remote-controlled inductive power transfer. System efficiency was enhanced using coil design optimization, and validated using numerical simulations and experimental analysis. Our pacemaker design was concepted to achieve inductive power transfer over a 55 mm range to a microscale pacer with a 3 mm diameter. Thus, the proposed system design enabled long-range wireless power transfer to a small implanted pacer with the capacity for intravascular deployment to the anterior cardiac vein. This proposed stent-like fixation mechanism can bypass the multitude of complications associated with pacemaker wires while wireless power can eliminate the need for repeated procedures for battery replacement.
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Affiliation(s)
- Parinaz Abiri
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.,Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Arash Abiri
- Department of Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Varun Gudapati
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Chih-Chiang Chang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Mehrdad Roustaei
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Hamed Bourenane
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Usama Anwar
- Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Dejan Markovic
- Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tzung K Hsiai
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA. .,Department of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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20
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21
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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22
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Abstract
Several clinical trials have established the role of cardiac resynchronization therapy in patients with heart failure, impaired left ventricular function and dyssynchrony. Challenges to traditional therapy include coronary sinus anatomy and failure to respond. Left ventricular endocardial pacing could overcome anatomic constraints, provide more flexibility, and allow for more physiologic activation. Cases and case series have demonstrated the promise of the approach. Preclinical studies support the superior hemodynamic effects of left ventricular endocardial pacing. Leadless left ventricular endocardial pacing is a recent innovation that is undergoing prospective testing. Successful delivery may be associated with clinical response and positive cardiac structural remodeling.
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Affiliation(s)
- Alan Hanley
- Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - E Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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23
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Bereuter L, Niederhauser T, Kucera M, Loosli D, Steib I, Schildknecht M, Zurbuchen A, Noti F, Tanner H, Reichlin T, Haeberlin A. Leadless cardiac resynchronization therapy: An in vivo proof-of-concept study of wireless pacemaker synchronization. Heart Rhythm 2019; 16:936-942. [PMID: 30639936 DOI: 10.1016/j.hrthm.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contemporary leadless pacemakers (PMs) only feature single-chamber ventricular pacing. However, the majority of patients require dual-chamber pacing or cardiac resynchronization therapy (CRT). Several leadless PMs implanted in the same heart would make that possible if they were able to synchronize their activity in an efficient, safe, and reliable way. Thus, a dedicated ultra-low-power wireless communication method for PM synchronization is required. OBJECTIVE The purpose of this study was to develop a leadless CRT system and to evaluate its function in vivo. METHODS Device synchronization was implemented using conductive intracardiac communication (CIC). Communication frequencies were optimized for intracardiac device-device communication. Energy consumption, safety, and reliability of the leadless PM system were tested in animal experiments. RESULTS We successfully performed CRT pacing with 3 independent devices synchronizing their action using CIC. No arrhythmias were induced by the novel communication technique. Ninety-eight percent of all communication impulses were transmitted successfully. The optimal communication frequency was around 1 MHz, with a corresponding transmitted power of only 0.3 μW at a heart rate of 60 bpm. CONCLUSION Leadless PMs are able to synchronize their action using CIC and may overcome the key limitation of contemporary leadless PMs.
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Affiliation(s)
- Lukas Bereuter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Thomas Niederhauser
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
| | - Martin Kucera
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
| | - Dominic Loosli
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
| | - Immanuel Steib
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
| | - Marcel Schildknecht
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland
| | - Adrian Zurbuchen
- Swiss Institute for Translational and Entrepreneurial Medicine, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Hôpital Haut-Lévêque, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.
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24
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Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Card Electrophysiol Clin 2019; 10:17-29. [PMID: 29428139 DOI: 10.1016/j.ccep.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leadless pacemaker therapy is a new technology that aims at avoiding lead- and pocket-related complications of conventional transvenous and epicardial pacing. To date, 2 self-contained leadless pacemakers for right ventricular pacing have been clinically available: the Nanostim Leadless Pacemaker System and the Micra Transcatheter Pacing System. Additionally, a new multicomponent leadless pacemaker for endocardial left ventricular pacing has been proposed as an alternative choice for cardiac resynchronization therapy. In this review, we describe the state of the art of leadless pacing and compare the currently available devices with traditional transvenous leadless pacemakers.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA.
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25
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Teall T, Webb J, Carr-White G, Rinaldi CA. Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions. Heart Fail Rev 2019; 24:41-54. [PMID: 30143910 PMCID: PMC6313376 DOI: 10.1007/s10741-018-9734-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart failure is a complex clinical syndrome associated with a significant morbidity and mortality burden. Reductions in left ventricular (LV) function trigger adaptive mechanisms, leading to structural changes within the LV and the potential development of dyssynchronous ventricular activation. This is the substrate targeted during cardiac resynchronisation therapy (CRT); however, around 30-50% of patients do not experience benefit from this treatment. Non-response occurs as a result of pre-implant, peri-implant and post implant factors but the technical constraints of traditional, transvenous epicardial CRT mean they can be challenging to overcome. In an effort to improve response, novel alternative methods of CRT delivery have been developed and of these endocardial pacing, where the LV is stimulated from inside the LV cavity, appears the most promising.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK.
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Thomas Teall
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Jessica Webb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Gerarld Carr-White
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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26
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Butter C, Fehrendt S, Möller V, Seifert M. [Leadless endocardial ultrasound based left ventricular stimulation : WISE CRT System: alternative to conventional methods]. Herzschrittmacherther Elektrophysiol 2018; 29:340-348. [PMID: 30406825 DOI: 10.1007/s00399-018-0605-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023]
Abstract
There are still several limitations in delivering cardiac resynchronisation therapy (CRT). After 6 months, 20-40% of patients fail to have clinical benefit due to various reasons. Endocardial stimulation rather than conventional epicardial pacing has been shown to be more physiological, improves electrical stimulation of the left ventricle (LV), has less dispersion of electrical activity and results in better resynchronisation. The WiSE™ CRT System ("Wireless stimulation endocardial system"; EBR Systems, Sunnyvale, CA, USA) provides an option for wireless, LV endocardial pacing triggered by a conventional right ventricular pacing spike from a co-implant. The feasibility of the WiSE™ CRT System has been successfully demonstrated in a population of failed cardiac resynchronisation patients with either failed implantation of a conventional system, nonresponse to conventional therapy or upgrade from pacemaker or defibrillator, where a conventional system was not an option. The WiSE™ CRT System is an innovative technology with promising safety, performance and preliminary efficacy.
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Affiliation(s)
- C Butter
- Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Abteilung für Kardiologie, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Straße 17, 16321, Bernau, Deutschland.
| | - S Fehrendt
- Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Abteilung für Kardiologie, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Straße 17, 16321, Bernau, Deutschland
| | - V Möller
- Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Abteilung für Kardiologie, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Straße 17, 16321, Bernau, Deutschland
| | - M Seifert
- Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Abteilung für Kardiologie, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Straße 17, 16321, Bernau, Deutschland
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Abstract
Bioelectronic microdevices are an emerging class of biomedical devices miniaturized at the scale of a millimeter or less, which promise new capabilities for monitoring and treating human disease. Although rapid progress has been made in the sensing and actuation capabilities of microdevices, a major technological challenge remains in the way that these devices are powered within the body. In this review, we revisit the power requirements of microdevices, describe current methods for storing, transferring or harvesting energy in microdevices, provide an overview of emerging powering approaches and discuss the promise of microdevices in biomedicine.
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Affiliation(s)
- Pui Mun Lee
- Department of Electrical & Computer Engineering, National University of Singapore, 117456, Singapore
| | - Ze Xiong
- Department of Electrical & Computer Engineering, National University of Singapore, 117456, Singapore
| | - John Ho
- Department of Electrical & Computer Engineering, National University of Singapore, 117456, Singapore
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28
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Johar S, Luqman N. Initial experience with a leadless pacemaker (Micra™) implantation in a low volume center in South East Asia. Future Cardiol 2018; 14:389-395. [PMID: 30251546 PMCID: PMC6190239 DOI: 10.2217/fca-2017-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: The Micra™ Transcatheter Pacing System is a leadless pacemaker that has been introduced recently. We share our experience in a low volume center and the use of right ventricular angiography (RVA) during implantation. Materials & methods: Patients underwent Micra implantation and RVA was performed to predetermine the implant site. Results: Nine patients underwent Micra implantation. The most common indication was atrial fibrillation with bradycardia. The device was implanted at apical-septum in seven and mid-septum in two. The procedure time ranged from 30 to 100 min and fluoroscopic time 4–18 min. Pacing parameters remained stable after 1-month follow-up. Conclusion: The Micra implantation technique can be easily learnt. RVA was helpful in selecting an appropriate site for the Micra implant.
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Affiliation(s)
- Sofian Johar
- Consultant Cardiologist & Electrophysiologist, Gleneagles JPMC & Cardiac Centre RIPAS Hospital, Bander Seri Begawan BA1710, Brunei Darussalam
| | - Nazar Luqman
- Consultant Cardiologist, Cardiac Centre RIPAS Hospital, Bander Seri Begawan BA1710, Brunei Darussalam
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29
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Bussooa A, Neale S, Mercer JR. Future of Smart Cardiovascular Implants. SENSORS 2018; 18:s18072008. [PMID: 29932154 PMCID: PMC6068883 DOI: 10.3390/s18072008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in Western society. Recent technological advances have opened the opportunity of developing new and innovative smart stent devices that have advanced electrical properties that can improve diagnosis and even treatment of previously intractable conditions, such as central line access failure, atherosclerosis and reporting on vascular grafts for renal dialysis. Here we review the latest advances in the field of cardiovascular medical implants, providing a broad overview of the application of their use in the context of cardiovascular disease rather than an in-depth analysis of the current state of the art. We cover their powering, communication and the challenges faced in their fabrication. We focus specifically on those devices required to maintain vascular access such as ones used to treat arterial disease, a major source of heart attacks and strokes. We look forward to advances in these technologies in the future and their implementation to improve the human condition.
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Affiliation(s)
- Anubhav Bussooa
- School of Engineering James Watt South Building, University of Glasgow, Glasgow G12 8QQ, UK.
- BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK.
| | - Steven Neale
- School of Engineering James Watt South Building, University of Glasgow, Glasgow G12 8QQ, UK.
| | - John R Mercer
- BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK.
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Novel Pacing Strategies for Heart Failure Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:64. [DOI: 10.1007/s11936-017-0561-3] [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: 11/30/2022]
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32
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Inductively powered wireless pacing via a miniature pacemaker and remote stimulation control system. Sci Rep 2017; 7:6180. [PMID: 28733677 PMCID: PMC5522478 DOI: 10.1038/s41598-017-06493-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022] Open
Abstract
Pacemakers have existed for decades as a means to restore cardiac electrical rhythms. However, lead-related complications have remained a clinical challenge. While market-released leadless devices have addressed some of the issues, their pacer-integrated batteries cause new health risks and functional limitations. Inductive power transfer enables wireless powering of bioelectronic devices; however, Specific Absorption Rate and size limitations reduce power efficiency for biomedical applications. We designed a remote-controlled system in which power requirements were significantly reduced via intermittent power transfer to control stimulation intervals. In parallel, the cardiac component was miniaturized to facilitate intravascular deployment into the anterior cardiac vein. Given size constraints, efficiency was optimal via a circular receiver coil wrapped into a half-cylinder with a meandering tail. The pacemaker was epicardially tested in a euthanized pig at 60 beats per minute, 2 V amplitude, and 1 ms pulse width, restoring mean arterial pressure from 0 to 37 mmHg. Power consumption was 1 mW at a range of > 3 cm with no misalignment and at 2 cm with 45° displacement misalignment, 45° x-axis angular misalignment, or 45° y-axis angular misalignment. Thus, we demonstrated a remote-controlled miniaturized pacing system with low power consumption, thereby providing a basis for the next generation of wireless implantable devices.
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Madhavan M, Mulpuru SK, McLeod CJ, Cha YM, Friedman PA. Advances and Future Directions in Cardiac Pacemakers: Part 2 of a 2-Part Series. J Am Coll Cardiol 2017; 69:211-235. [PMID: 28081830 DOI: 10.1016/j.jacc.2016.10.064] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
In the second part of this 2-part series on pacemakers, we present recent advances in pacemakers and preview future developments. Cardiac resynchronization therapy (CRT) is a potent treatment for heart failure in the setting of ventricular dyssynchrony. Successful CRT using coronary venous pacing depends on appropriate patient selection, lead implantation, and device programming. Despite optimization of these factors, nonresponse to CRT may occur in one-third of patients, which has led to a search for alternative techniques such as multisite pacing, His bundle pacing, and endocardial left ventricular pacing. A paradigm shift in pacemaker technology has been the development of leadless pacemaker devices, and on the horizon is the development of batteryless devices. Remote monitoring has ushered in an era of greater safety and the ability to respond to device malfunction in a timely fashion, improving outcomes.
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Affiliation(s)
- Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Mullens W, Nijst P. Leadless Left Ventricular Pacing: Another Step Toward Improved CRT Response. J Am Coll Cardiol 2017; 69:2130-2133. [PMID: 28449773 DOI: 10.1016/j.jacc.2017.03.534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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35
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El-Chami MF, Merchant FM, Leon AR. Leadless Pacemakers. Am J Cardiol 2017; 119:145-148. [PMID: 27889044 DOI: 10.1016/j.amjcard.2016.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 02/01/2023]
Abstract
Leadless pacing is an emerging technology with the potential to significantly improve outcomes associated with the need for long-term pacing. Specifically, the major advantage of leadless systems is abolishing the need for transvenous leads and subcutaneous pockets, both of which account for most adverse events associated with traditional pacemakers. Two leadless pacemakers are currently available: the Nanostim (leadless cardiac pacemaker [LCP]) device (St. Jude Medical, Sylmar, California) and the Micra Transcatheter pacing system (Medtronic, Minneapolis, Minnesota). These 2 pacemakers have shown promising results in clinical trials. In conclusion, in this review we summarize the results of the 2 investigational device exemption trials and compare the pros and cons of these devices to traditional transvenous pacemakers.
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Affiliation(s)
- Mikhael F El-Chami
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
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36
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Non-invasive cardiac pacing with image-guided focused ultrasound. Sci Rep 2016; 6:36534. [PMID: 27827415 PMCID: PMC5101517 DOI: 10.1038/srep36534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/17/2016] [Indexed: 11/11/2022] Open
Abstract
Currently, no non-invasive cardiac pacing device acceptable for prolonged use in conscious patients exists. High Intensity Focused Ultrasound (HIFU) can be used to perform remote pacing using reversibility of electromechanical coupling of cardiomyocytes. Here we described an extracorporeal cardiac stimulation device and study its efficacy and safety. We conducted experiments ex vivo and in vivo in a large animal model (pig) to evaluate clinical potential of such a technique. The stimulation threshold was determined in 10 different ex vivo hearts and different clinically relevant electrical effects such as consecutive stimulations of different heart chambers with a single ultrasonic probe, continuous pacing or the inducibility of ventricular tachycardia were shown. Using ultrasonic contrast agent, consistent cardiac stimulation was achievable in vivo for up to 1 hour sessions in 4 different animals. No damage was observed in inversion-recovery MR sequences performed in vivo in the 4 animals. Histological analysis revealed no differences between stimulated and control regions, for all ex vivo and in vivo cases.
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37
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Thomas DE, Child NM, Owens WA, Linker NJ, James SA, Turley AJ. Cardiac resynchronization therapy in coronary sinus atresia delivered using leadless endocardial pacing. HeartRhythm Case Rep 2016; 2:432-435. [PMID: 28491727 PMCID: PMC5419969 DOI: 10.1016/j.hrcr.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Dewi E. Thomas
- Division of Cardiothoracic Services, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Nicholas M. Child
- Department of Cardiology, University of North Tees, Stockton-on-Tees, United Kingdom
| | - W. Andrew Owens
- Division of Cardiothoracic Services, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Nicholas J. Linker
- Division of Cardiothoracic Services, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Simon A. James
- Division of Cardiothoracic Services, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Andrew J. Turley
- Division of Cardiothoracic Services, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
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Villemain O, Kwiecinski W, Bel A, Robin J, Bruneval P, Arnal B, Tanter M, Pernot M, Messas E. Pulsed cavitational ultrasound for non-invasive chordal cutting guided by real-time 3D echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1101-7. [DOI: 10.1093/ehjci/jew145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 04/10/2016] [Indexed: 01/12/2023] Open
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Innovative pacing: Recent advances, emerging technologies, and future directions in cardiac pacing. Trends Cardiovasc Med 2016; 26:452-63. [PMID: 27017442 DOI: 10.1016/j.tcm.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022]
Abstract
The field of cardiovascular medicine is rapidly evolving as advancements in technology and engineering provide clinicians new and exciting ways to care for an aging population. Cardiac pacing, in particular, has seen a series of game-changing technologies emerge in the past several years spurred by low-power electronics, high density batteries, improved catheter delivery systems and innovative software design. We look at several of these emerging pacemaker technologies, discussing the rationale, current state and future directions of these pioneering developments in electrophysiology.
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Leadless Cardiac Devices-Pacemakers and Implantable Cardioverter-Defibrillators. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:49. [PMID: 27287746 DOI: 10.1007/s11936-016-0472-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Since the initial introduction of pacemakers and defibrillators, the rapid growth in microcircuit and battery technology has increased the longevity demands and exposed the vulnerabilities of transvenous leads. Over a half of century later, leadless pacemaker and defibrillation systems are just reaching the clinical arena. Despite the remarkable advantages of leadless pacing systems, the data are still quite limited and broad implementation of these technologies need to occur in a cautious and deliberate fashion as the peri-procedural risks remains high. Two of the three systems, Nanostim(TM) (St. Jude Medical) and Micra Transcatheter Pacing System (Medtronic Inc.), have shown the greatest applicability, although they are currently only limited to single chamber pacing and procedural risks are modest. The WiCS(TM)-LV system (EBR Systems, Inc.) is anatomically limited and benefits a small subset of patients. Leadless implantable cardioverter-defibrillator (ICD) therapy, the subcutaneous ICD (S-ICD, Cameron Health/Boston Scientific), has demonstrated encouraging short-term safety and efficacy data supporting its use. Since its introduction, modifications to the implant procedure, pre-screening of patients, and programming of the devices have reduced procedural-related complications and inappropriate shocks. The S-ICD is a promising technology, but it is premature to conclude that it will supplant conventional ICDs. At this current time, the S-ICD may benefit select patients, such as those with recurrent bacteremia, vascular access limitations, and who may be prone to transvenous lead failure.
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41
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Seifert M, Butter C. Evaluation of wireless stimulation of the endocardium, WiSE, technology for treatment heart failure. Expert Rev Med Devices 2016; 13:523-31. [DOI: 10.1080/17434440.2016.1187559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ebrille E, DeSimone CV, Vaidya VR, Chahal AA, Nkomo VT, Asirvatham SJ. Ventricular pacing - Electromechanical consequences and valvular function. Indian Pacing Electrophysiol J 2016; 16:19-30. [PMID: 27485561 PMCID: PMC4936653 DOI: 10.1016/j.ipej.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although great strides have been made in the areas of ventricular pacing, it is still appreciated that dyssynchrony can be malignant, and that appropriately placed pacing leads may ameliorate mechanical dyssynchrony. However, the unknowns at present include: 1. The mechanisms by which ventricular pacing itself can induce dyssynchrony; 2. Whether or not various pacing locations can decrease the deleterious effects caused by ventricular pacing; 3. The impact of novel methods of pacing, such as atrioventricular septal, lead-less, and far-field surface stimulation; 4. The utility of ECG and echocardiography in predicting response to therapy and/or development of dyssynchrony in the setting of cardiac resynchronization therapy (CRT) lead placement; 5. The impact of ventricular pacing-induced dyssynchrony on valvular function, and how lead position correlates to potential improvement. This review examines the existing literature to put these issues into context, to provide a basis for understanding how electrical, mechanical, and functional aspects of the heart can be distorted with ventricular pacing. We highlight the central role of the mitral valve and its function as it relates to pacing strategies, especially in the setting of CRT. We also provide future directions for improved pacing modalities via alternative pacing sites and speculate over mechanisms on how lead position may affect the critical function of the mitral valve and thus overall efficacy of CRT.
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Affiliation(s)
- Elisa Ebrille
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Anwar A Chahal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Clinical and Translational Science, Mayo Graduate School, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Abstract
Cardiac resynchronisation therapy (CRT) is an important therapy for patients with heart failure with a reduced ejection fraction and interventricular conduction delay. Large trials have established the role of CRT in reducing heart failure hospitalisations and improving symptoms, left ventricular (LV) function and mortality. Guidelines from major medical societies are consistent in support of CRT for patients with New York Health Association (NYHA) class II, III and ambulatory class IV heart failure, reduced LV ejection fraction and QRS prolongation, particularly left bundle branch block. The current challenge facing practitioners is to maximise the rate of patients who respond to CRT and the magnitude of that response. Current areas of interest for achieving these goals include tailoring patient selection, individualising LV lead placement and application of new technologies and techniques for CRT delivery.
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Affiliation(s)
- Geoffrey F Lewis
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
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44
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The subcutaneous implantable cardioverter defibrillator: state-of-the-art review. Eur Heart J 2015; 38:247-257. [DOI: 10.1093/eurheartj/ehv507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/14/2015] [Accepted: 09/07/2015] [Indexed: 01/20/2023] Open
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Dokainish H, Elbarasi E, Masiero S, Van de Heyning C, Brambatti M, Ghazal S, Al-Maashani S, Capucci A, Buikema L, Leong D, Shivalkar B, Saenen J, Miljoen H, Morillo C, Divarakarmenon S, Amit G, Ribas S, Brautigam A, Baiocco E, Maolo A, Romandini A, Maffei S, Connolly S, Healey J. Prospective study of tricuspid valve regurgitation associated with permanent leads in patients undergoing cardiac rhythm device implantation: Background, rationale, and design. Glob Cardiol Sci Pract 2015; 2015:41. [PMID: 26779517 PMCID: PMC4633575 DOI: 10.5339/gcsp.2015.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/30/2015] [Indexed: 11/03/2022] Open
Abstract
Given the increasing numbers of cardiac device implantations worldwide, it is important to determine whether permanent endocardial leads across the tricuspid valve can promote tricuspid regurgitation (TR). Virtually all current data is retrospective, and indicates a signal of TR being increased after permanent lead implantation. However, the precise incidence of moderate or greater TR post-procedure, the exact mechanisms (mechanical, traumatic, functional), and the hemodynamic burden and clinical effects of this putative increase in TR, remain uncertain. We have therefore designed a multicenter, international, prospective study of 300 consecutive patients (recruitment completed, baseline data presented) who will undergo echocardiography and clinical assessment prior to, and at 1-year post device insertion. This prospective study will help determine whether cardiac device-associated TR is real, what are its potential mechanisms, and whether it has an important clinical impact on cardiac device patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Amit
- McMaster University, Hamilton, ON, Canada
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46
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Seriwala HM, Khan MS, Munir MB, Riaz IB, Riaz H, Saba S, Voigt AH. Leadless pacemakers: A new era in cardiac pacing. J Cardiol 2015; 67:1-5. [PMID: 26458791 DOI: 10.1016/j.jjcc.2015.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/02/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
Abstract
Cardiac pacemakers are a critical management option for patients with rhythm disorders. Current efforts to develop leadless pacemakers have two primary goals: to reduce lead-associated post-procedural morbidity and to avoid the surgical scar associated with placement. After extensive studies on animal models and technological advancements, these devices are currently under investigation for human use. Herein, we review the evidence from animal studies and the technological advancements that have ushered in the era of use in humans. We also discuss different leadless pacemakers currently under investigation, along with limitations and future developments of this innovative concept.
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Affiliation(s)
| | | | - Muhammad Bilal Munir
- Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Irbaz Bin Riaz
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Samir Saba
- Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew H Voigt
- Cardiovascular Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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47
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Asif SM, Hansen J, Khan MS, Walden SD, Jensen MO, Braaten BD, Ewert DL. Design and In Vivo Test of a Batteryless and Fully Wireless Implantable Asynchronous Pacing System. IEEE Trans Biomed Eng 2015; 63:1070-1081. [PMID: 26357395 DOI: 10.1109/tbme.2015.2477403] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Goal: The aim of this study is to develop a novel fully wireless and batteryless technology for cardiac pacing. METHODS This technology uses radio frequency (RF) energy to power the implanted electrode in the heart. An implantable electrode antenna was designed for 1.2 GHz; then, it was tested in vitro and, subsequently, integrated with the rectifier and pacing circuit to make a complete electrode. The prototype implanted electrode was tested in vivo in an ovine subject, implanting it on the epicardial surface of the left ventricle. The RF energy, however, was transmitted to the implanted electrode using a horn antenna positioned 25 cm above the thorax of the sheep. RESULTS It was demonstrated that a small implanted electrode can capture and harvest enough safe recommended RF energy to achieve pacing. Electrocardiogram signals were recorded during the experiments, which demonstrated asynchronous pacing achieved at three different rates. CONCLUSION These results show that the proposed method has a great potential to be used for stimulating the heart and provides pacing, without requiring any leads or batteries. It hence has the advantage of potentially lasting indefinitely and may never require replacement during the life of the patient. SIGNIFICANCE The proposed method brings forward transformational possibilities in wireless cardiac pacing, and also in powering up the implantable devices.
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48
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Miller MA, Neuzil P, Dukkipati SR, Reddy VY. Leadless Cardiac Pacemakers. J Am Coll Cardiol 2015; 66:1179-89. [PMID: 26337997 DOI: 10.1016/j.jacc.2015.06.1081] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine, New York, New York
| | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine, New York, New York.
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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50
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