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Henley T, Goudy J, Easterling M, Donley C, Wirka R, Bressan M. Local tissue mechanics control cardiac pacemaker cell embryonic patterning. Life Sci Alliance 2023; 6:e202201799. [PMID: 36973005 PMCID: PMC10043993 DOI: 10.26508/lsa.202201799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Cardiac pacemaker cells (CPCs) initiate the electric impulses that drive the rhythmic beating of the heart. CPCs reside in a heterogeneous, ECM-rich microenvironment termed the sinoatrial node (SAN). Surprisingly, little is known regarding the biochemical composition or mechanical properties of the SAN, and how the unique structural characteristics present in this region of the heart influence CPC function remains poorly understood. Here, we have identified that SAN development involves the construction of a "soft" macromolecular ECM that specifically encapsulates CPCs. In addition, we demonstrate that subjecting embryonic CPCs to substrate stiffnesses higher than those measured in vivo results in loss of coherent electrical oscillation and dysregulation of the HCN4 and NCX1 ion channels required for CPC automaticity. Collectively, these data indicate that local mechanics play a critical role in maintaining the embryonic CPC function while also quantitatively defining the range of material properties that are optimal for embryonic CPC maturation.
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Affiliation(s)
- Trevor Henley
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie Goudy
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marietta Easterling
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrie Donley
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Wirka
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael Bressan
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Shirwaiker A, William J, Mariani JA, Kistler PM, Patel HC, Voskoboinik A. Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience. Heart Lung Circ 2022; 31:993-998. [PMID: 35219598 DOI: 10.1016/j.hlc.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The long-term implications of pacemaker insertion in younger adults are poorly described in the literature. METHODS We performed a retrospective analysis of consecutive younger adult patients (18-50 yrs) undergoing pacemaker implantation at a quaternary hospital between 1986-2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed. RESULTS Eighty-one (81) patients (median age 41.0 yrs IQR=35-47.0, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.9 (IQR=1.1-14.9) years follow-up, nine patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation [n=11], device infection [n=1] and pocket revision [n=1]). Five (5) of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further nine patients (11%) experienced pacemaker-related morbidity from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in two patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and seven of these patients required subsequent biventricular upgrade. Furthermore, four patients (5%) developed new tricuspid regurgitation (>moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients. CONCLUSIONS Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
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Affiliation(s)
| | | | - Justin A Mariani
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Peter M Kistler
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | - Hitesh C Patel
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia.
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Li DL, Yoneda ZT, Issa TZ, Shoemaker MB, Montgomery JA. Prevalence and predictors of pacing-induced cardiomyopathy in young adult patients (<60 years) with pacemakers. J Cardiovasc Electrophysiol 2021; 32:1961-1968. [PMID: 33825250 DOI: 10.1111/jce.15029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical trials and observational studies of pacing-induced cardiomyopathy (PICM) have largely included elderly patients with mean age >70 years. The prevalence and predictors of PICM in younger patients (age < 60 years) after pacemaker implantation are not known. METHODS Adults (18-59 years) who received single-chamber ventricular or dual-chamber pacemakers at Vanderbilt University Medical Center from 1986 to 2015 were included. Patients without documented ventricular pacing burden and patients with baseline left ventricular ejection fraction (LVEF) <35% were excluded. PICM was defined as LVEF decrease of ≥ 10% and LVEF < 50% during follow-up with right ventricular pacing ≥20%, and without alternative explanations for cardiomyopathy. RESULTS A total of 325 patients were included in the study. During a median follow-up duration of 11.5 (Interquartile range 7-17) years, 38 patients (11.7%) developed PICM (1.3 per 100 patient-year). Older age (HR 2.5 for age ≥50 years, p = .013), reduced baseline LVEF (HR 2.4, p = .022), and preimplant AVB (HR 2.7, p = .007) were associated with an increased risk of PICM in the multivariate analysis. Furthermore, baseline AF conferred an increased risk of PICM only in patients without preimplant AVB but not patients with pre-implant AVB. CONCLUSIONS The incidence of PICM in young patients was low, but PICM could occur more than a decade after pacemaker implantation. Older age, baseline reduced LVEF, and preimplant AVB were associated with an increased risk of PICM in the young patient cohort.
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Affiliation(s)
- Dan L Li
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zachary T Yoneda
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tariq Z Issa
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - M Benjamin Shoemaker
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jay A Montgomery
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Yuyun MF, Bonny A, Ng GA, Sliwa K, Kengne AP, Chin A, Mocumbi AO, Ngantcha M, Ajijola OA, Bukhman G. A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa. Glob Heart 2020; 15:37. [PMID: 32923331 PMCID: PMC7413135 DOI: 10.5334/gh.808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights - Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.
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Affiliation(s)
- Matthew F. Yuyun
- Department of Medicine, Harvard Medical School, Boston, US
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, US
| | - Aimé Bonny
- District Hospital Bonassama, Douala/University of Douala, CM
- Homeland Heart Centre, Douala, CM
- Centre Hospitalier Montfermeil, Unité de Rythmologie, Montfermeil, FR
| | - G. André Ng
- National Institute for Health Research Leicester Biomedical Research Centre, Department of Cardiovascular Sciences, University of Leicester, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, ZA
| | - Andre Pascal Kengne
- South African Medical Research Council and Department of Medicine, University of Cape Town, ZA
| | - Ashley Chin
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, ZA
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Universidade Eduardo Mondlane, Maputo, MZ
| | | | | | - Gene Bukhman
- Department of Medicine, Harvard Medical School, Boston, US
- Division of Cardiovascular Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, US
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, US
- NCD Synergies project, Partners In Health, Boston, US
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Paton MF, Gierula J, Jamil HA, Lowry JE, Byrom R, Gillott RG, Chumun H, Cubbon RM, Cairns DA, Stocken DD, Kearney MT, Witte KK. Optimising pacemaker therapy and medical therapy in pacemaker patients for heart failure: protocol for the OPT-PACE randomised controlled trial. BMJ Open 2019; 9:e028613. [PMID: 31320354 PMCID: PMC6661620 DOI: 10.1136/bmjopen-2018-028613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Permanent artificial pacemaker implantation is a safe and effective treatment for bradycardia and is associated with extended longevity and improved quality of life. However, the most common long-term complication of standard pacemaker therapy is pacemaker-associated heart failure. Pacemaker follow-up is potentially an opportunity to screen for heart failure to assess and optimise patient devices and medical therapy. METHODS AND ANALYSIS The study is a multicentre, phase-3 randomised trial. The 1200 participants will be people who have a permanent pacemaker for bradycardia for at least 12 months, randomly assigned to undergo a transthoracic echocardiogram with their pacemaker check, thereby tailoring their management directed by left ventricular function or the pacemaker check alone, continuing with routine follow-up. The primary outcome measure is time to all-cause mortality or heart failure hospitalisation. Secondary outcomes include external validation of our risk stratification model to predict onset of heart failure and quality of life assessment. ETHICS AND DISSEMINATION The trial design and protocol have received national ethical approval (12/YH/0487). The results of this randomised trial will be published in international peer-reviewed journals, communicated to healthcare professionals and patient involvement groups and highlighted using social media campaigns. TRIAL REGISTRATION NUMBER NCT01819662.
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Affiliation(s)
- Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Haqeel A Jamil
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Judith E Lowry
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Rowena Byrom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Richard G Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hemant Chumun
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Percutaneous Microwave Tumor Ablation Is Safe in Patients with Cardiovascular Implantable Electronic Devices: A Single-Institutional Retrospective Review. J Vasc Interv Radiol 2019; 30:396-400. [PMID: 30819482 DOI: 10.1016/j.jvir.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/21/2022] Open
Abstract
The risk of electromagnetic interference between microwave (MW) ablation and cardiac implantable electronic devices (CIEDs), ie, pacemakers and defibrillators, has not been fully evaluated. Fourteen MW ablations (kidney, n = 8; liver, n = 5; lung, n = 1) were performed in 13 patients with CIEDs in normal operating mode. Electrocardiography tracings, cardiovascular complications, tumor size, tumor-to-CIED distance, and tumor-to-device lead distance were recorded. Mean tumor size was 2.9 cm, mean tumor-to-CIED distance was 26.4 cm (range, 9-30 cm), and mean tumor-to-lead distance was 12.1 cm (range, 3.5-20 cm). No device-based cardiovascular complications or class C or higher complications per Society of Interventional Radiology criteria were identified. MW ablation appears to be safe in select patients with CIEDs.
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7
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Ngatchou W, Kamdem F, Lemogoum D, Ewane DF, Doualla MS, Jansens JL, Sango J, Origer P, Hacquebard JJ, Berre J, de Cannière D, Alima MB, Dzudie A, Ngote H, Mouliom S, Hentchoua R, Kana A, Coulibaly A, Jingi AM, Mfeukeu-Kuaté L, Priso EB, Luma H, Ménanga AP, Kingue S. Late mortality after cardiac interventions over 10-year period in two Cameroonian government-owned hospitals. Cardiovasc Diagn Ther 2019; 9:43-49. [PMID: 30881876 DOI: 10.21037/cdt.2018.11.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiac surgery is a growing activity in Sub-Saharan Africa, however, data related to long-term mortality are scarce. We aimed to analyze outcome data of cardiac interventions in two hospitals in Cameroon over 10 years' period. Methods we conducted a retrospective analytical and descriptive study at the Douala General Hospital and Yaoundé General Hospital. All patients operated between January 2007 and December 2017, or their families were contacted by phone between January and April 2018 for a free of charges medical examination. Results Of a total of 98 patients operated during the study period, 8 (8.2%) were lost to follow-up. Finally, 90 patients [49 (54.4%) women and 41 (45.6%)] men were included. The mean age was 49±22 years (range, 13-89 years). The surgical indications were valvular heart diseases in 37 (41.1%) cases, congenital heart diseases in 11 (12.2%) cases, chronic constrictive pericarditis in 4 (4.4%) cases, and intra cardiac tumor in 1 (1.1%) case. Valve replacement was the most common type of surgery carried out in 37 (41.1%) cases-mostly with mechanical prosthesis. Pacemaker-mostly dual-chambers were implanted in 36 (40.0%) patients. The median follow-up was 26 months. The overall late mortality was 5.7%, and the overall survival rates at 5 and 10 years were 95.5% and 94.4% respectively. The overall survival rates at 5 and 10 years for mechanical valve prosthesis were 93.3% and 90% respectively. The survival at 10 years was 100% for patients with bioprosthesis. The survival rates at 10 years were 94.1% and 100% respectively for dual and single chamber pacemaker. Conclusions Long-term outcome of cardiac surgery in hospitals in Cameroon are acceptable with low mortality rate. However, outcome metrics beyond mortality should be implemented for a prospective data collection.
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Affiliation(s)
- William Ngatchou
- Faculty of Medicine and Pharmaceutical Sciences of Douala, Douala, Cameroon
| | - Félicité Kamdem
- Faculty of Medicine and Pharmaceutical Sciences of Douala, Douala, Cameroon.,Internal Medicine Department, Douala General Hospital, Douala, Cameroon
| | - Daniel Lemogoum
- Faculty of Medicine and Pharmaceutical Sciences of Douala, Douala, Cameroon
| | | | - Marie Solange Doualla
- Faculty of Medicine and Pharmaceutical Sciences of Douala, Douala, Cameroon.,Internal Medicine Department, Douala General Hospital, Douala, Cameroon
| | - Jean Luc Jansens
- Department of Cardiac Surgery, Erasme Hospital of Brussels, ULB, Belgium
| | - Joseph Sango
- Faculty of Medicine and Pharmaceutical Sciences of Douala, Douala, Cameroon
| | - Pierre Origer
- Department of Anesthesiology, St Pierre Hospital of Brussels, ULB, Belgium
| | | | - Jacques Berre
- Department of Cardiac Surgery, Erasme Hospital of Brussels, ULB, Belgium
| | | | | | - Anastase Dzudie
- Internal Medicine Department, Douala General Hospital, Douala, Cameroon
| | - Henry Ngote
- Internal Medicine Department, Douala General Hospital, Douala, Cameroon
| | - Sidiki Mouliom
- Internal Medicine Department, Douala General Hospital, Douala, Cameroon
| | - Romuald Hentchoua
- Anesthesiology and Intensive Care Units, Douala General Hospital, Douala, Cameroon
| | - Albert Kana
- Anesthesiology and Intensive Care Units, Douala General Hospital, Douala, Cameroon
| | - Aminata Coulibaly
- Anesthesiology and Intensive Care Units, Douala General Hospital, Douala, Cameroon
| | - Ahmadou M Jingi
- Faculty of Medicine and Biomedical Sciences of Yaoundé, Yaoundé, Cameroon
| | | | | | - Henry Luma
- Faculty of Medicine and Biomedical Sciences of Yaoundé, Yaoundé, Cameroon
| | | | - Samuel Kingue
- Department of Cardiology, Yaoundé General Hospital, Yaoundé, Cameroon
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Dębski M, Ulman M, Ząbek A, Boczar K, Haberka K, Kuniewicz M, Lelakowski J, Małecka B. Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant. Cardiol J 2018; 26:717-726. [PMID: 30155863 DOI: 10.5603/cj.a2018.0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in comparison to the age- and sex-matched general population, assess changes in baseline characteristics over three decades of the inclusion period and determine the association between selected variables and patient survival. METHODS This longitudinal study of consecutive de novo DDD pacemaker implantations performed between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter university hospital. RESULTS Under assessment were 3928 patients with a total of 30,087 patient-years of survival time. Compared to the general population, the observed survival was significantly inferior until 12 years post DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics over three decades revealed the following significant changes: more elderly patients, more female patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter (AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades. In multivariate analysis male sex and higher age were the only variables significantly associated with shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device infection were not associated with survival. CONCLUSIONS In the very-long-term follow-up of DDD pacemaker patients, the parameters associated with survival were sex and baseline age at first implantation.
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Affiliation(s)
- Maciej Dębski
- Department of Electrocardiology John Paul II Hospital in Krakow.
| | - Mateusz Ulman
- Department of Electrocardiology John Paul II Hospital in Krakow
| | - Andrzej Ząbek
- Department of Electrocardiology John Paul II Hospital in Krakow
| | | | | | - Marcin Kuniewicz
- Department of Electrocardiology John Paul II Hospital in Krakow.,Department of Anatomy, Jagiellonian University Medical College, Krakow
| | - Jacek Lelakowski
- Department of Electrocardiology John Paul II Hospital in Krakow.,Institute of Cardiology, Jagiellonian University Medical College, Krakow
| | - Barbara Małecka
- Department of Electrocardiology John Paul II Hospital in Krakow.,Institute of Cardiology, Jagiellonian University Medical College, Krakow
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Rajaeefard A, Ghorbani M, Babaee Baigi MA, Tabatabae H. Ten-year Survival and Its Associated Factors in the Patients Undergoing Pacemaker Implantation in Hospitals Affiliated to Shiraz University of Medical Sciences During 2002 - 2012. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 17:e20744. [PMID: 26734484 PMCID: PMC4698316 DOI: 10.5812/ircmj.20744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 05/22/2015] [Accepted: 06/21/2015] [Indexed: 11/28/2022]
Abstract
Background: Heart failure is a prevalent disease affecting about 4.9 million people in the U.S. and more than 22 million individuals worldwide. Using electric pacemaker is the most common treatment for the patients with heart conduction problems. The present study aimed to determine the factors affecting survival in the patients undergoing pacemaker implantation in the hospitals affiliated to Shiraz University of Medical Sciences. Objectives: The aim of the present study was to identify the factors affecting the survival of the patients suffering from arrhythmia. Patients and Methods: This retrospective survival analysis was conducted on all 1207 patients with heart failure who had undergone permanent pacemaker implantation in the hospitals affiliated to Shiraz University of Medical Sciences from 2002 to 2012. The data were analyzed using non-parametric methods such as Kaplan-Meier method, life table, and Cox regression model. The risk factors of mortality were determined using multivariate Cox proportional hazards method. Results: Survival data were available for 1030 (80%) patients (median age = 71 years [5th to 95th percentile range: 26 - 86 years]) and follow-up was completed for 84.28% of them. According to the results, 56% of the patients had received dual-chamber systems, while 44% had been implanted by single-chamber ventricular systems. Moreover, sick sinus syndrome and pacemaker mode were independent predictors of increased mortality. Conclusions: In this study, sick sinus syndrome and pacemaker mode followed by syncope were independently associated with increased mortality.
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Affiliation(s)
- Abdolreza Rajaeefard
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Abdolreza Rajaeefard, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7137251001, Fax: +98-7137260225, E-mail:
| | - Mohammad Ghorbani
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Hamidreza Tabatabae
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Ward JL, DeFrancesco TC, Tou SP, Atkins CE, Griffith EH, Keene BW. Complication rates associated with transvenous pacemaker implantation in dogs with high-grade atrioventricular block performed during versus after normal business hours. J Vet Intern Med 2015; 29:157-63. [PMID: 25619513 PMCID: PMC4858108 DOI: 10.1111/jvim.12512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/04/2014] [Accepted: 10/28/2014] [Indexed: 12/04/2022] Open
Abstract
Background Transvenous pacemaker implantation in dogs is associated with a relatively high complication rate. At our institution, pacemaker implantation in dogs with high‐grade atrioventricular block (HG‐AVB) frequently is performed as an after‐hours emergency. Hypothesis Among dogs with HG‐AVB, the rate of major complications is higher when pacemakers are implanted after hours (AH) compared to during business hours (BH). Animals Client‐owned dogs with HG‐AVB that underwent transvenous pacemaker implantation between January 2002 and December 2012 at the North Carolina State University Veterinary Teaching Hospital. Methods Retrospective medical record review. Two‐year follow‐up was required for complications analysis. Results Major complications occurred in 14/79 dogs (18%) and included lead dislodgement, lead or generator infection, lead or generator migration, and pacing failure. Incidence of major complications was significantly higher AH (10/36, 28%) compared to BH (4/43, 9%; P = .041), and all infectious complications occurred AH. Median survival time for all dogs was 27 months and did not differ between AH and BH groups for either all‐cause (P = .70) or cardiac (P = .40) mortality. AH dogs were younger than BH dogs (P = .010), but there were no other clinically relevant differences between BH and AH groups in terms of demographic, clinical, or procedural variables. Conclusions and Clinical Importance At our institution, AH transvenous pacemaker placement is associated with a higher rate of major complications (especially infections) compared to BH placement. This difference may be because of a variety of human factor differences AH versus BH.
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Affiliation(s)
- J L Ward
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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Udo EO, van Hemel NM, Zuithoff NPA, Doevendans PA, Moons KGM. Prognosis of the bradycardia pacemaker recipient assessed at first implantation: a nationwide cohort study. Heart 2013; 99:1573-8. [DOI: 10.1136/heartjnl-2013-304445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Udo EO, van Hemel NM, Zuithoff NPA, Kelder JC, Crommentuijn HA, Koopman-Verhagen AM, Voskuil T, Doevendans PAFM, Moons KGM. Long-term outcome of cardiac pacing in octogenarians and nonagenarians. Europace 2011; 14:502-8. [DOI: 10.1093/europace/eur329] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVES To document the outcome, survival and complications involved in pacemaker implantation in dogs in a retrospective study. METHODS Case records for all dogs in which pacemaker implantation was performed were reviewed. RESULTS A total of 104 dogs underwent pacemaker implantation. Dogs were presented with atrioventricular (AV) block (71), sick sinus syndrome (25) or vasovagal syncope (eight). Age at presentation varied from six months to 13 years with a median age of seven years and two months. The Labrador was the most commonly represented breed (17 cases). All but one dog survived pacemaker implantation, with 93 showing resolution of their clinical signs while 10 dogs showed intermittent residual signs. One-, three- and five-year survival estimates were 86, 65 and 39 per cent, respectively. Major complications after implantation were documented in 15 dogs and three of these led to fatalities. Minor complications were noted in 23 dogs. Sudden death occurred in six dogs three to 55 months following successful pacemaker implantation. CLINICAL SIGNIFICANCE Transvenous pacemaker implantation was successful in reducing or eliminating clinical signs in over 90 per cent of dogs with third-degree atrioventricular (AV) block or sick sinus syndrome. In dogs with vasovagal syncope, six of eight dogs had greatly reduced frequency of collapse and two became asymptomatic. Although the procedure was associated with complications, these were rarely life threatening and good survival was documented in the majority of cases.
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Affiliation(s)
- M S Johnson
- Veterinary Cardiorespiratory Centre, 43 Waverley Road, Kenilworth, Warwickshire CV8 1JL
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15
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Sherman SC, Holmes M. Third degree heart block in a young man. J Emerg Med 2005; 29:479-81. [PMID: 16243212 DOI: 10.1016/j.jemermed.2005.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 02/23/2005] [Accepted: 04/01/2005] [Indexed: 05/05/2023]
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Shaw DB, Gowers JI, Kekwick CA, New KHJ, Whistance AWT. Is Mobitz type I atrioventricular block benign in adults? BRITISH HEART JOURNAL 2004; 90:169-74. [PMID: 14729789 PMCID: PMC1768048 DOI: 10.1136/hrt.2003.017806] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the need for pacing in adults with chronic Mobitz type I second degree atrioventricular block (Mobitz I). DESIGN Prospective study. SETTING District general hospital. PATIENTS 147 subjects aged > or = 20 years (age cohorts 20-44, 45-64, 65-79, and > or = 80) with chronic Mobitz I without second degree Mobitz II or third degree (higher degree) block on entry, seen from 1968 to 1993 and followed up to 30 June 1997. Sixty four had organic heart disease. The presence of symptomatic bradycardia was defined as highly likely in 47 patients (class 1); probable in 14 (class 2); and absent in 86 (class 3). INTERVENTIONS Pacemakers were implanted in 90 patients for the following indications: symptoms in 74 and prophylaxis in 16. MAIN OUTCOME MEASURES The main outcome measure was death, with conduction deterioration to higher degree block or symptomatic bradycardia the alternative measure. RESULTS Five year survival to death was reduced in unpaced patients relative to that expected for the normal population (overall mean (SD) 53.5 (6.7)% v 68.6%, p < 0.001; class 3, 54.4 (7.3)% v 70.1%, p < 0.001). Paced patients fared better than unpaced (overall (mean (SD) five year survival 76.3 (4.5)% v 53.5 (6.7)%, p = 0.0014; class 3, 87.2 (5.4)% v 54.4 (7.3)%, p = 0.020; and organic heart disease, 68.2 (7.6)% v 44.0 (9.9)%, p < or = 0.0014). There were no deaths in the < 45 cohort. Survival to first outcome (main or alternative) was further reduced to 31.7 (5.0)% in 102 patients unpaced initially and 34.2 (5.7)% in class 3. Only the 20-44 cohort and patients with sinus arrhythmia had > 50% survival. CONCLUSION Mobitz I block is not usually benign in patients > or = 45 years of age. Pacemaker implantation should be considered, even in the absence of symptomatic bradycardia or organic heart disease.
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Affiliation(s)
- D B Shaw
- Cardiac Department, Royal Devon and Exeter Hospital, Exeter, UK.
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Oyama MA, Sisson DD, Lehmkuhl LB. Practices and Outcome of Artificial Cardiac Pacing in 154 Dogs. J Vet Intern Med 2001. [DOI: 10.1111/j.1939-1676.2001.tb02316.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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