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Hofer D, Perucchini F, Blessberger H, Steinwender C, Zehetleitner S, Molitor N, Saguner AM, El-Chami MF, Black G, Schiavone M, Forleo G, Gasperetti A, Steffel J, Noti F, Haeberlin A, Breitenstein A. Electrocardiographic predictors of atrial mechanical sensing in leadless pacemakers. Heart Rhythm 2024; 21:1072-1080. [PMID: 38432424 DOI: 10.1016/j.hrthm.2024.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Leadless pacemakers (LPs) capable of VDD pacing allow for atrioventricular synchrony through mechanical sensing of atrial contraction. However, mechanical sensing is less reliable and less predictable than electrical sensing. OBJECTIVE The purpose of this study was to evaluate P-wave amplitude during sinus rhythm from preoperative 12-lead electrocardiograms (ECGs) as a predictor for atrial mechanical sensing in patients undergoing VDD LP implantation. METHODS Consecutive patients undergoing VDD LP implantation were included in this 2-center prospective cohort study. ECG parameters were evaluated separately and in combination for association with the signal amplitude of atrial mechanical contraction (A4). RESULTS Eighty patients (median age 82 years; female 55%; mean body mass index [BMI] 25.8 kg/m2) were included in the study and 61 patients in the A4 signal analysis (19 patients in VVI mode during follow-up). Absolute (aVL, aVF, V1, V2) and BMI-adjusted (I, II, aVL, aVF, aVR, V1, V2) P-wave amplitudes from baseline ECGs demonstrated a statistically significant positive correlation with A4 signal amplitude (all P <.05). A combined P-wave signal amplitude of at least 0.2 mV in V1 and aVL was predictive, with specificity of 83% (95% confidence interval 67%-100%) for A4 signal ≥1 m/s2. We found a significant correlation of A4 signal amplitude and overall atrioventricular synchrony (P = .013). CONCLUSION P-wave amplitudes in ECG leads aVL and V1 can predict A4 signal amplitude in patients with VDD LP and therefore the probability of successful AV synchronous pacing.
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Affiliation(s)
- Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Fabrizio Perucchini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Samantha Zehetleitner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Molitor
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - George Black
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giovanni Forleo
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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2
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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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3
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Vardas PE. Leadless and scarless pacing: towards symbiotic nanogenerators. Eur Heart J 2024; 45:1252-1254. [PMID: 38442144 DOI: 10.1093/eurheartj/ehae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Panos E Vardas
- Medical School, University of Crete, Heraklion, Greece
- Biomedical Research Foundation Academy of Athens, Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, Athens 15123, Greece
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4
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Liu CM, Chen YC, Hu YF. Harnessing cell reprogramming for cardiac biological pacing. J Biomed Sci 2023; 30:74. [PMID: 37633890 PMCID: PMC10463311 DOI: 10.1186/s12929-023-00970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
Electrical impulses from cardiac pacemaker cardiomyocytes initiate cardiac contraction and blood pumping and maintain life. Abnormal electrical impulses bring patients with low heart rates to cardiac arrest. The current therapy is to implant electronic devices to generate backup electricity. However, complications inherent to electronic devices remain unbearable suffering. Therefore, cardiac biological pacing has been developed as a hardware-free alternative. The approaches to generating biological pacing have evolved recently using cell reprogramming technology to generate pacemaker cardiomyocytes in-vivo or in-vitro. Different from conventional methods by electrical re-engineering, reprogramming-based biological pacing recapitulates various phenotypes of de novo pacemaker cardiomyocytes and is more physiological, efficient, and easy for clinical implementation. This article reviews the present state of the art in reprogramming-based biological pacing. We begin with the rationale for this new approach and review its advances in creating a biological pacemaker to treat bradyarrhythmia.
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Affiliation(s)
- Chih-Min Liu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
- Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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5
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Defaye P, Biffi M, El-Chami M, Boveda S, Glikson M, Piccini J, Vitolo M. Cardiac pacing and lead devices management: 25 years of research at EP Europace journal. Europace 2023; 25:euad202. [PMID: 37421338 PMCID: PMC10450798 DOI: 10.1093/europace/euad202] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Cardiac pacing represents a key element in the field of electrophysiology and the treatment of conduction diseases. Since the first issue published in 1999, EP Europace has significantly contributed to the development and dissemination of the research in this area. METHODS In the last 25 years, there has been a continuous improvement of technologies and a great expansion of clinical indications making the field of cardiac pacing a fertile ground for research still today. Pacemaker technology has rapidly evolved, from the first external devices with limited longevity, passing through conventional transvenous pacemakers to leadless devices. Constant innovations in pacemaker size, longevity, pacing mode, algorithms, and remote monitoring highlight that the fascinating and exciting journey of cardiac pacing is not over yet. CONCLUSION The aim of the present review is to provide the current 'state of the art' on cardiac pacing highlighting the most important contributions from the Journal in the field.
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Affiliation(s)
- Pascal Defaye
- Cardiology Department, University Hospital and Grenoble Alpes University, CS 10217, Grenoble Cedex 9, Grenoble 38043, France
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
| | - Michael Glikson
- Cardiology Department, Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jonathan Piccini
- Duke University, Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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6
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Vouliotis AI, Roberts PR, Dilaveris P, Gatzoulis K, Yue A, Tsioufis K. Leadless Pacemakers: Current Achievements and Future Perspectives. Eur Cardiol 2023; 18:e49. [PMID: 37655133 PMCID: PMC10466270 DOI: 10.15420/ecr.2022.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/18/2022] [Indexed: 09/02/2023] Open
Abstract
Despite the technological advances in pacemaker technology, the transvenous implanted leads are still considered the Achilles' heel of this rhythm-control therapy. The leadless permanent pacemaker system was developed as an option to bypass the weakness of the transvenous approach. Advances in battery technology and deep miniaturisation of electronics now offer the opportunity to implant the whole pacemaker system into the right ventricle. This review aims to provide a comprehensive report on the advent of leadless pacemakers, their clinical usefulness and the future perspectives of this disruptive and promising technology. Further research is required before some of these technologies are safely and routinely used in clinical practice.
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Affiliation(s)
- Apostolos Ilias Vouliotis
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Paul R Roberts
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
| | - Polychronis Dilaveris
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Konstantinos Gatzoulis
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Arthur Yue
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
| | - Konstantinos Tsioufis
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
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7
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Li QY, Dong JZ, Guo CJ, Fang DP, Liu X, Dai WL. Initial studies on the implanting sites of high and low ventricular septa using leadless cardiac pacemakers. Ann Noninvasive Electrocardiol 2023:e13068. [PMID: 37342981 DOI: 10.1111/anec.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/09/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVE To study the safety and electrical characteristics of various implanting sites of the Micra pacemaker. METHOD A total of 15 patients from Beijing Anzhen Hospital, Capital Medical University, were included, who were implanted with Micra leadless pacemakers and allocated to either the high ventricular septum group (eight patients) or the low ventricular septum group (seven patients) based on their individual patient factors and clinical conditions. The baseline of the patients, the implanting area, the electrocardiogram change after implantation, the implantation data, the threshold, R wave, impedance, and the date of the 1-month follow-up were then analyzed. With all of the data, the characteristics of different implantation sites of the Micra pacemaker were determined. RESULTS Overall, the thresholds were low at implantation and remained stable over the 1-, 3-, 6-month, 1-, 2-, 3-, and 4-year follow-ups. On comparing the two groups, there was no difference in QRS duration at pacing (140.00 [40.00] ms vs. 179.00 [50.00] ms), threshold at implantation (0.38 [0.22] mV vs. 0.63 [1.00] mV), R wave at implantation ([10.85 ± 4.71] V vs. [7.26 ± 2.98] V), or impedance at implantation ([906.25 ± 162.39] Ω vs. [750.00 ± 173.40] Ω). While the difference in QRS duration between the two groups was not significant, the QRS duration of the high ventricular septum group exhibited a reduced tendency compared with that of the low ventricular group. The corrected QT interval during pacing exhibited a significant difference (440.00 [80.00] ms vs. 520.00 [100.00] ms; p < .05). For the 1-, 3-, 6-month, 1-, 2-, 3-, and 4-year follow-ups, there was no difference between the threshold of the high ventricular septum group and that of the low ventricular septum group (p > .05). CONCLUSION High ventricular septum pacing appears to be a safe site for implantation of the Micra pacemaker. It could entail a shorter QRS duration at pacing and could be more physiological than low ventricular septum pacing.
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Affiliation(s)
- Qiao-Yuan Li
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cheng-Jun Guo
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dong-Ping Fang
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Liu
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen-Long Dai
- The Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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8
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Viola GM, Szvalb AD, Malek AE, Chaftari AM, Hachem R, Raad II. Prevention of device-related infections in patients with cancer: Current practice and future horizons. CA Cancer J Clin 2023; 73:147-163. [PMID: 36149820 PMCID: PMC9992006 DOI: 10.3322/caac.21756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients' oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life-saving cancer therapy. Herein, the authors comprehensively review multiple evidence-based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device-related infections. The authors present many general principles for the prevention of these infections followed by specific device-related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control-targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Malaczynska-Rajpold K, Elliot M, Wijesuriya N, Mehta V, Wong T, Rinaldi CA, Behar JM. Leadless Cardiac Pacing: New Horizons. Cardiol Ther 2023; 12:21-33. [PMID: 36417178 PMCID: PMC9986180 DOI: 10.1007/s40119-022-00288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Since the introduction of transvenous cardiac pacing leads, pacemaker system design has remained similar for several decades. Progressive miniaturisation of electronic circuitry and batteries has enabled a smaller, single pacing unit comprising the intracardiac electrodes, generator and computer. This review explores the development of leadless pacing, the clinical trials comparing leadless to transvenous pacing in addition to the future developments of multi-chamber leadless pacing.
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Affiliation(s)
- Katarzyna Malaczynska-Rajpold
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK
| | - Mark Elliot
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Nadeev Wijesuriya
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Vishal Mehta
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK
| | - Christopher Aldo Rinaldi
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Jonathan M Behar
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK.
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK.
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10
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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11
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Hu Q, Chen K, Dai Y, Zhang S. Micra leadless pacemaker retrieval for broken tines: a case report. Clin Res Cardiol 2022; 111:1295-1298. [PMID: 35419628 DOI: 10.1007/s00392-022-02025-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/06/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 N Lishi Rd, Xicheng District, Beijing, 10037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 N Lishi Rd, Xicheng District, Beijing, 10037, China.
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 N Lishi Rd, Xicheng District, Beijing, 10037, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 N Lishi Rd, Xicheng District, Beijing, 10037, China
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12
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ZHENG CL, ZHAO L, CHEN Y, XU ZM, LIU L, WANG LL, LIU YM. The feasibility of leadless pacemaker implantation in nonagenarians: case report and literature review. J Geriatr Cardiol 2022; 19:626-630. [PMID: 36339472 PMCID: PMC9629999 DOI: 10.11909/j.issn.1671-5411.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Chun-Ling ZHENG
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li ZHAO
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yu CHEN
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zheng-Ming XU
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling LIU
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li-Li WANG
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying-Ming LIU
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
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13
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ElRefai M, Menexi C, Abouelasaad M, Nettey D, Roberts PR. A leadless pacemaker matched with a vasovagal syncope: how long can it last? Pacing Clin Electrophysiol 2022; 45:874-884. [PMID: 35691000 DOI: 10.1111/pace.14546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Guidelines recommend that cardiac pacing should be considered in patients suffering from frequent vasovagal syncopal (VVS) episodes. Studies have demonstrated the safety and efficacy of leadless pacemakers (LP) in cardioinhibitory vasovagal populations specifically, rendering them a reasonable alternative to transvenous pacing in these patients. However, due to the paucity of data on extraction and the number of concomitant LPs that can be safely implanted, there are concerns regarding LPs' battery longevity, especially in younger patients who may require decades of pacing therapy. METHODS This is a retrospective analysis of the first 100 LPs implanted at a tertiary cardiac centre in the UK. Demographical data and device parameters at implant and follow-ups were obtained from the hospital's medical records. The battery life of the LPs in the VVS patients was compared to that of patients with other pacing indications. RESULTS Ninety patients were included in the analysis. 14 patients (15.6%) had VVS, and 76 patients (84.4%) had other indications for pacing. Mean ages were 34 ± 13 years and 62 ± 20 years for the VVS and the other group, respectively. The estimated total battery life was 15.22 ± 0.35 and 13.65 ± 2.97 years in the VVS and the other indications group respectively (p = .04). There were no complications in the VVS group. CONCLUSION LPs provide a promising treatment for patients with vasovagal syncope with reassuring battery performance at the short/intermediate term. Further longer-term follow-up data are needed to identify the true battery potential in this patient cohort.
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Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Christina Menexi
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Diana Nettey
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
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14
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Kabutoya T, Imai Y, Aoyama Y, Toriumi S, Yokota A, Komori T, Kario K. Leadless Pacemaker Implantation for a Super-elderly Woman with a Mediastinal Tumor. Intern Med 2022; 61:1545-1547. [PMID: 34670897 PMCID: PMC9177370 DOI: 10.2169/internalmedicine.8273-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022] Open
Abstract
A 95-year-old woman with no cardiac history presented with symptomatic complete atrioventricular block. She underwent temporary cardiac pacing via the cervical vein, but a pacing lead could not be introduced via the usual route because of a mediastinal tumor. A leadless pacemaker (Micra™; Medtronic, Minneapolis, USA) was implanted at the right ventricular septum via the right femoral vein. The procedure time was 40 minutes, with no complications noted. Over the two-year follow-up period, the threshold and impedance remained stable. The implantation of a leadless pacemaker was useful for improving the symptoms of a super-elderly woman with a mediastinal tumor.
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Affiliation(s)
| | - Yasushi Imai
- Jichi Medical University School of Medicine, Japan
| | | | | | - Ayako Yokota
- Jichi Medical University School of Medicine, Japan
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15
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Domenichini G, Le Bloa M, Carroz P, Graf D, Herrera-Siklody C, Teres C, Porretta AP, Pascale P, Pruvot E. New Insights in Central Venous Disorders. The Role of Transvenous Lead Extractions. Front Cardiovasc Med 2022; 9:783576. [PMID: 35282352 PMCID: PMC8904723 DOI: 10.3389/fcvm.2022.783576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with a higher incidence of transvenous lead complications over time. Variable degrees of venous stenosis at the level of the subclavian vein, the innominate trunk and the superior vena cava are reported in up to 50% of implanted patients. Importantly, the number of implanted leads seems to be the main risk factor for such complications. Extraction of abandoned or dysfunctional leads is a potential solution to overcome venous stenosis in case of device upgrades requiring additional leads, but also, in addition to venous angioplasty and stenting, to reduce symptoms related to the venous stenosis itself, i.e., the superior vena cava syndrome. This review explores the role of transvenous lead extraction procedures as therapeutical option in case of central venous disorders related to transvenous cardiac leads. We also describe the different extraction techniques available and other clinical indications for lead extractions such as lead infections. Finally, we discuss the alternative therapeutic options for cardiac stimulation or defibrillation in case of chronic venous occlusions that preclude the implant of conventional transvenous cardiac devices.
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16
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Utilization of leadless pacemaker following transvenous lead extraction: a series of 10 successful cases. HeartRhythm Case Rep 2022; 8:292-295. [PMID: 35497474 PMCID: PMC9039085 DOI: 10.1016/j.hrcr.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Doldi F, Biller B, Reinke F, Eckardt L. [New developments in leadless pacing systems]. Herz 2021; 46:513-519. [PMID: 34686910 DOI: 10.1007/s00059-021-05075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
Leadless pacing systems, especially the Micra™ TPS system, deliver an effective and safe alternative to the previous conventional transvenous systems in patients with impossible transvenous access and seem to be compatible with other implantable devices (S-ICD, deep brain stimulators) with no limitations in efficacy or safety. Also, new outlooks on leadless resynchronization therapy seem promising and could prevent future patients from lead- or operation-associated complications. Current limits to the implementation in everyday clinical practice are mostly the unavailability of the devices or cost issues through lack of health insurance reimbursement. However, more promising data through further studies and rising implantation rates are expected based on the positive current clinical data.
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Affiliation(s)
- Florian Doldi
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland.
| | - Benedikt Biller
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
| | - Florian Reinke
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
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18
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Elliott MK, Sidhu BS, Mehta VS, Gould J, Martic D, Rinaldi CA. The importance of leadless pacemaker positioning in relation to subcutaneous implantable cardioverter-defibrillator sensing in completely leadless cardiac resynchronization and defibrillation systems. HeartRhythm Case Rep 2021; 7:628-632. [PMID: 34552857 PMCID: PMC8441212 DOI: 10.1016/j.hrcr.2021.06.006] [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: 11/23/2022] Open
Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dejana Martic
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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19
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Lenarczyk R, Boveda S, Mansourati J, Russo V, Marijon E, Lane DA, Dagres N, Potpara TS. Peri-procedural management, implantation feasibility, and short-term outcomes in patients undergoing implantation of leadless pacemakers: European Snapshot Survey. Europace 2021; 22:833-838. [PMID: 32073116 DOI: 10.1093/europace/euaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess procedural settings, safety measures, and short-term outcomes associated with implantation of leadless pacemakers (LLPM), across a broad range of tertiary European electrophysiology centres. An internet-based electronic questionnaire (30 questions) concerning implantation settings, peri-procedural routines, complications, and in-hospital patient outcomes was circulated to centres routinely implanting both LLPMs and transvenous pacemakers (TV-PM). The centres were requested to prospectively include consecutive patients implanted with either LLPMs or TV-PMs during the 10-week enrolment period. Overall, 21 centres from four countries enrolled 825 consecutive patients between November 2018 and January 2019, including 69 (9%) implanted with LLPMs. Leadless pacemakers were implanted mainly under local anaesthesia (69%), by an electrophysiologist (60%), in the electrophysiology laboratory (71%); 95% of patients received prophylactic antibiotics prior to implantation. Most patients on chronic oral anticoagulation were operated on-drug (35%), or during short-term (to 48 h) drug withdrawal (54%). Implantation was successful in 98% of patients and the only in-hospital procedure-related complication was groyne haematoma in one patient. This EHRA snapshot survey provides important insights into LLPM implantation routines and patient outcomes. These findings suggest that despite the unfavourable clinical profile of pacemaker recipients, LLPM implantation is associated with relatively low risk of complications and good short-term outcomes.
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Affiliation(s)
- Radosław Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Serge Boveda
- Cardiology - Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium.,Paris University, PARCC-INSERM, 56 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, 9 Rue Félix le Dantec, 29200 Brest, France.,ORPHY, Université de Bretagne Occidentale, 3 Rue des Archives, 29238 Brest, France
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Via Santa Maria di Costantinopoli 104, Napoli, NA 80138, Italy
| | - Eloi Marijon
- Paris University, PARCC-INSERM, 56 Rue Leblanc, 75908 Paris Cedex 15, France.,Cardiology Department, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Søndre Skovvej 15, Forskningens Hus, 9000 Aalborg, Denmark
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000 Belgrad, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Visegradska 26, 11000 Belgrade, Serbia
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20
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Arroyo NA, Gessert T, Hitchcock M, Tao M, Smith CD, Greenberg C, Fernandes-Taylor S, Francis DO. What Promotes Surgeon Practice Change? A Scoping Review of Innovation Adoption in Surgical Practice. Ann Surg 2021; 273:474-482. [PMID: 33055590 PMCID: PMC10777662 DOI: 10.1097/sla.0000000000004355] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. BACKGROUND In an era of accelerated innovations, surgeons face the difficult decision to either acknowledge and implement or forgo new advances. Although changing surgical practice to align with evidence is an imperative of health systems, evidence-based guidelines have not translated into consistent change. The literature on practice change is limited and has largely focused on synthesizing information on methods and trials to evaluate innovative surgical interventions. No reviews to date have grounded their analysis within an implementation science framework. METHODS A systematic review of the literature on surgical practice change was performed. Abstracts and full-text articles were reviewed for relevance using inclusion and exclusion criteria and data were extracted from each article. Cited facilitators and barriers were then mapped across domains within the implementation science Theoretical Domains Framework and expanded to the Capability, Opportunity, Motivation, and Behavior model. RESULTS Components of the Capability, Opportunity, Motivation, and Behavior model were represented across the Theoretical Domains Framework domains and acted as both facilitators and barriers to practice change depending on the circumstances. Domains that most affected surgical practice change, in order, were: opportunity (environmental context and resources and social influences), capability (knowledge and skills), and motivation (beliefs about consequences and reinforcement). CONCLUSIONS Practice change is predicated on a conducive environment with adequate resources, but once that is established, the surgeon's individual characteristics, including skills, motivation, and reinforcement determine the likelihood of successful change. Deficiencies in the literature underscore the need for further study of resource interventions and the role of surgical team dynamics in the adoption of innovation. A better understanding of these areas is needed to optimize our ability to disseminate and implement best practices in surgery.
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Affiliation(s)
- Natalia A. Arroyo
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas Gessert
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mary Hitchcock
- Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael Tao
- Department of Otolaryngology, The State University of New York, Syracuse, New York
| | - Cara Damico Smith
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Caprice Greenberg
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sara Fernandes-Taylor
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - David O. Francis
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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21
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Abstract
Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.
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22
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Biffi M, Capobianco C, Spadotto A, Bartoli L, Sorrentino S, Minguzzi A, Piemontese GP, Angeletti A, Toniolo S, Statuto G. Pacing devices to treat bradycardia: current status and future perspectives. Expert Rev Med Devices 2020; 18:161-177. [PMID: 33336616 DOI: 10.1080/17434440.2021.1866543] [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] [Indexed: 10/22/2022]
Abstract
Introduction: Cardiac stimulation evolved from life-saving devices to prevent asystole to the treatment of heart rhythm disorders and heart failure, capable of remote patient and disease-progression monitoring. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases.Areas covered: Clinical experience, as per available literature, has led to awareness of the concealed risks of customary cardiac pacing, that can inadvertently cause atrio-ventricular and inter/intra-ventricular dyssynchrony. New pacing modalities have emerged, leading to a new concept of what truly represents 'physiologic pacing' beyond maintenance of atrio-ventricular coupling. In this article we will analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing, and the hints of future developments.Expert opinion: 'physiologic stimulation' technologies should evolve to enable an effective and widespread adoption. In one way new guiding catheters and the adoption of electrophysiologic guidance and non-fluoroscopic lead implantation are needed to make His-Purkinje pacing successful and effective at long term in a shorter procedure time; in the other way leadless stimulation needs to upgrade to a superior physiologic setting to mimic customary DDD pacing and possibly His-Purkinje pacing.
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Affiliation(s)
- Mauro Biffi
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Claudio Capobianco
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Alberto Spadotto
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Lorenzo Bartoli
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Sergio Sorrentino
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Alessandro Minguzzi
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Giuseppe Pio Piemontese
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Andrea Angeletti
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Sebastiano Toniolo
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Giovanni Statuto
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
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23
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Curnis A, Salghetti F, Cerini M, Fabbricatore D, Ghizzoni G, Arrigoni L, Generati G, Arabia G, Maiolo V, Aboelhassan M, Bontempi L. Leadless pacemaker: State of the art and incoming developments to broaden indications. Pacing Clin Electrophysiol 2020; 43:1428-1437. [DOI: 10.1111/pace.14097] [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: 05/25/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Curnis
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Francesca Salghetti
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Manuel Cerini
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Davide Fabbricatore
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Giulia Ghizzoni
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Luca Arrigoni
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Greta Generati
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Gianmarco Arabia
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Vincenzo Maiolo
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | | | - Luca Bontempi
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
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24
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Papageorgiou N, Falconer D, Wyeth N, Lloyd G, Pellerin D, Speechly-Dick E, Segal OR, Lowe M, Rowland E, Lambiase PD, Chow AW, Bhattacharyya S. Effect of tricuspid regurgitation and right ventricular dysfunction on long-term mortality in patients undergoing cardiac devices implantation: >10-year follow-up study. Int J Cardiol 2020; 319:52-56. [DOI: 10.1016/j.ijcard.2020.05.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
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26
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Oliveira SF, Carvalho MM, Adão L, Nunes JP. Clinical outcomes of leadless pacemaker: a systematic review. Minerva Cardiol Angiol 2020; 69:346-357. [PMID: 32657558 DOI: 10.23736/s2724-5683.20.05244-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Transvenous pacemakers are associated with a significant amount of complications. Leadless pacemakers (LP) are emerging as an alternative to conventional devices. This article provides a systematic review of patient eligibility, safety and clinical outcomes of the LP devices. EVIDENCE ACQUISITION A systematic search for articles describing the use of LP was conducted. Out of two databases, 24 articles were included in the qualitative analysis. These articles comprised a total of 4739 patients, with follow-up times of 1-38 months. Further information was obtained from 10 more studies. EVIDENCE SYNTHESIS From a population of 4739 patients included in the qualitative analysis, 4670 LP were implanted with success (98.5%). A total of 248 complications were described (5.23%) during the follow-up. The most common were pacing issues such as elevated thresholds, dislodgements or battery failure (68 patients), events at the femoral access site such as hemorrhage, hematoma or pseudoaneurysms (64 patients) and procedure related cardiac injuries such as cardiac perforation, tamponade or pericardial effusion (47 patients). There were 360 deaths during the follow-up and 11 were described as procedure or device related. Four studies presented the strategy of using a combined approach of atrioventricular node ablation (AVNA) and LP implantation. CONCLUSIONS Leadless pacemakers seem to have a relatively low complication rate. These devices may be a good option in patients with an indication for single-chamber pacing, in patients with conditions precluding conventional transvenous pacemaker implantations. Studies directly comparing LP and transvenous pacemakers and data on longer follow-up periods are needed.
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Affiliation(s)
| | - Miguel M Carvalho
- Faculty of Medicine, University of Porto, Porto, Portugal.,São João University Hospital, Porto, Portugal
| | - Luís Adão
- São João University Hospital, Porto, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto, Portugal.,São João University Hospital, Porto, Portugal
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27
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Boveda S, Bartoletti S. Do patients need to adapt to technology improvements? Europace 2019; 21:1605-1606. [DOI: 10.1093/europace/euz252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 45, Avenue de Lombez, Toulouse, France
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefano Bartoletti
- Heart Rhythm Department, Clinique Pasteur, 45, Avenue de Lombez, Toulouse, France
- Liverpool Heart and Chest Hospital, Liverpool, UK
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28
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Leadless pacemakers - The path to safer pacing? Indian Heart J 2019; 71:431-433. [PMID: 32248913 PMCID: PMC7136320 DOI: 10.1016/j.ihj.2019.11.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/28/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Abstract
Endocardial transvenous permanent pacemakers (TVPs) are a mainstay within cardiology and used to treat a range of bradyarrhythmias. However, their use is associated with potential complications both at the time of implantation and longer term. The concept of a leadless pacemaker, where a self-contained device is placed within the right ventricle, has obvious attractions. Two leadless systems have been developed, though only one is currently available. Results from clinical trials have been promising but a number of hurdles need to be circumvented before leadless devices can usurp TVPs. At present, use is restricted to specialist centres, for a limited indication and for patients in whom conventional implantation is contraindicated. This article provides a contemporary critique of design types, evidence base and existing limitations of this nascent technology.
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Hain A, Hamm C, Sperzel J. [Symptomatic bradycardia with exitblock in a leadless pacemaker]. Herzschrittmacherther Elektrophysiol 2018; 29:401-405. [PMID: 30367235 DOI: 10.1007/s00399-018-0594-7] [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: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
The pacemaker is the treatment of choice for symptomatic bradycardic arrhythmias. However, pacemaker patients may develop further bradycardial arrhythmias, often due to a pacemaker dysfunction. The possible causes range from lead problems to complete system failure. The NanostimTM system is a leadless pacemaker. The advantages include the lead-free design and the catheter-based implantation. In 2016, all NanostimTM implantations were stopped due to a battery dysfunction.
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Affiliation(s)
- Andreas Hain
- Abteilung für Kardiologie/Elektrophysiologie, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Christian Hamm
- Abteilung für Kardiologie/Elektrophysiologie, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | - Johannes Sperzel
- Abteilung für Kardiologie/Elektrophysiologie, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
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Nanostim-leadless pacemaker. Herzschrittmacherther Elektrophysiol 2018; 29:327-333. [PMID: 30341551 DOI: 10.1007/s00399-018-0598-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022]
Abstract
Nanostim™ (St. Jude Medical Inc., Saint Paul, MN, USA; now Abbott Medical Inc. Abbott Park, IL, USA) was the first self-contained intracardiac pacemaker to be implanted in a human patient. A total of 1423 Nanostim devices were implanted worldwide between 2013 and 2016 and three clinical trials were initiated. Although the device was recalled in 2016 owing to rare but serious battery failures, the concept of leadless pacing has gained widespread acceptance and is expanding beyond the initial single-chamber devices to dual-chamber systems, biventricular pacing, and combinations with defibrillators. This review describes the design, results from initial clinical trials, and long-term experiences with Nanostim. It discusses the lessons learned from the pioneering device's successes and shortcomings, many of which are valid for leadless pacemakers in general. This article also considers the Nanostim experience in comparison with the early years of clinical use for other pioneering device therapies. Important questions include how to minimize the risk for short-term complications by appropriate operator training and evaluation of suitable patients, what the long-term performance tells us about safety, as well as the necessity and feasibility of device explantation.
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Stellbrink C, Hansky B, Meyer zu Vilsendorf D. Sondenlose Schrittmacher und subkutan implantierbare Kardioverter-Defibrillatoren. Internist (Berl) 2018; 59:999-1010. [DOI: 10.1007/s00108-018-0476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Valiton V, Graf D, Pruvot E, Carroz P, Fromer M, Bisch L, Tran VN, Cook S, Scharf C, Burri H. Leadless pacing using the transcatheter pacing system (Micra TPS) in the real world: initial Swiss experience from the Romandie region. Europace 2018; 21:275-280. [DOI: 10.1093/europace/euy195] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/10/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Valérian Valiton
- Department of Cardiology, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Denis Graf
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrice Carroz
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
- Department of Cardiology, Sion Hospital
| | - Martin Fromer
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurence Bisch
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vân Nam Tran
- Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | | | - Haran Burri
- Department of Cardiology, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
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