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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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Lane JD, Whittaker-Axon S, Schilling RJ, Lowe MD. Trends in implantable cardioverter defibrillator and cardiac resynchronisation therapy lead parameters for patients with arrhythmogenic and dilated cardiomyopathies. Indian Pacing Electrophysiol J 2019; 19:49-54. [PMID: 30145313 PMCID: PMC6450828 DOI: 10.1016/j.ipej.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) lead parameters may deteriorate due to right ventricular (RV) disease such as arrhythmogenic right ventricular cardiomyopathy (ARVC), with implications for safe delivery of therapies. We compared ICD and CRT-D (cardiac resynchronisation therapy-defibrillator) lead parameters in patients with ARVC and dilated cardiomyopathy (DCM). METHODS RV lead sensing (R wave amplitude) and pacing (threshold and amplitude-pulse width product (APWP)), left ventricular (LV) pacing (APWP), and imaging parameter trends were assessed in 18 patients with ARVC and 18 with DCM. RESULTS R wave amplitude did not change significantly over time in either group (over 5 years, ARVC -0.4 mV, 95% CI -3.8-3.0 mV; DCM -1.8 mV, 95% CI -5.0-1.3 mV). Within ARVC group, divergent trends were seen according to lead position. DCM patients experienced an increase in RV lead threshold (+1.1 V over 5 years, 95% CI + 0.5 to +1.7 V) and RV APWP (+0.48 Vms over 5 years, 95% CI + 0.24 to +0.71 Vms); ARVC patients had no change. ARVC patients had a higher LVEF at baseline than DCM patients (52 vs 20%, p < 0.001), though LVEF decreased over time for the former, while increasing for the latter. TAPSE did not change over time for ARVC patients. CONCLUSIONS Lead parameters in ARVC patients were stable over medium-term follow up. In DCM patients, RV lead threshold and RV and LV APWP increased over time. These differential responses for DCM and ARVC were not explained by imaging indices, and may reflect distinct patterns of disease progression.
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Affiliation(s)
- Jem D Lane
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom; Department of Cardiac Electrophysiology, Heart Hospital, 16-18 Westmoreland St, Marylebone, London, W1G 8PH, United Kingdom.
| | - Sarah Whittaker-Axon
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom
| | - Richard J Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom
| | - Martin D Lowe
- Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom; Department of Cardiac Electrophysiology, Heart Hospital, 16-18 Westmoreland St, Marylebone, London, W1G 8PH, United Kingdom
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Chávez-González E, Barja LD, Ortega DF, Pérez-Rodríguez A. Estimulación eléctrica permanente en región septal en pacientes con insuficiencia cardíaca secundaria a estimulación en ápex de ventrículo derecho. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:474-482. [DOI: 10.1016/j.acmx.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022] Open
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Peng H, Sun Z, Zhang H, Ma W. Long-term performance of right ventricular pacing leads: risk factors associated with permanent right ventricular pacing threshold increase. J Interv Card Electrophysiol 2018; 55:349-357. [PMID: 30402790 PMCID: PMC6694072 DOI: 10.1007/s10840-018-0481-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
Purpose Right ventricular pacing threshold (RVPT) may rise over time accompanied by the increased use of implantable cardiac pacemakers. However, risk factors for permanent RVPT increase are not fully clarified in patients without definite lead fracture and dislodgment. We aimed to evaluate the long-term performance of RV pacing leads and identify risk factors associated with the occurrence of permanent RVPT increase in this population. Methods Patients with first implantation of cardiac pacemakers from January 2008 to June 2016 were consecutively enrolled. Follow-up for RVPT increase was until December 2017. The clinical data, specific data on the pacemaker implantation, and routine follow-up were retrieved. Results During a follow-up duration of 5.4 ± 2.1 years, permanent RVPT increase (except lead fracture and dislodgment) was found in 8.4% (87/1033) patients. Patients with permanent RVPT increase had higher prevalence of myocardial infarction (MI), diabetes, and the use of amiodarone. The risk factors independently associated with permanent RVPT increase were MI (HR = 1.094, 95% CI 1.014–1.180, p = 0.031), diabetes (HR = 2.804, 95% CI 1.064–3.775, p = 0.003). MI patients with RVPT increase had higher prevalence of multivessel disease and atrioventricular block. Diabetic patients with RVPT increase exhibited higher serum fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels, which were correlated with the maximum RVPT (p < 0.001). Conclusions Our data showed that permanent RVPT increases (except lead fracture and dislodgement) during long-term follow-up after pacemaker implantation. The likely risk factors predisposing to chronic permanent RVPT increase are MI and diabetes with higher FBG and HbA1c levels.
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Affiliation(s)
- Hui Peng
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China.
| | - Zhijun Sun
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China
| | - Heping Zhang
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China
| | - Wenying Ma
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China
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5
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Yu Z, Chen R, Su Y, Chen X, Qin S, Li M, Han F, Ge J. Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis. BMC Cardiovasc Disord 2017; 17:221. [PMID: 28800733 PMCID: PMC5553603 DOI: 10.1186/s12872-017-0649-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Long-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP). Methods Published studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis. Results HBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% – 6.1%), lower NYHA class (WMD = −0.5, 95% CI: -0.7 – -0.3), WMD of LVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml), less inter-ventricular asynchrony (WMD = −13.2 ms, 95% CI: -16.4 – -10.0 ms), and shorter QRS duration for long-term (WMD = −36.9 ms, 95% CI: -40.0 – -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = −2.4 ml, 95% CI: -5.0 – 0.2 ml; WMDLVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml) compared to RVP. Conclusions The efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0649-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ziqing Yu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ruizhen Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fei Han
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
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Mizukami A, Matsue Y, Naruse Y, Kowase S, Kurosaki K, Suzuki M, Matsumura A, Nogami A, Aonuma K, Hashimoto Y. Implications of right ventricular septal pacing for medium-term prognosis: Propensity-matched analysis. Int J Cardiol 2016; 220:214-8. [PMID: 27389444 DOI: 10.1016/j.ijcard.2016.06.250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/15/2016] [Accepted: 06/26/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The effect of right ventricular (RV) septal pacing as opposed to RV apical pacing on prognosis in patients undergoing pacemaker implantation remains controversial. This study was performed to examine the clinical efficacy of RV septal pacing in a large cohort with medium-term follow-up and propensity-matched analysis. METHODS A total of 982 consecutive patients with first pacemaker implantation between 2008 and 2013 at two centers in Japan (51.4% male, age 76.1±10.6years, 64.3% septal pacing, 94% preserved ejection fraction [EF]) were enrolled. Propensity matching successfully matched 446 patients into RV septal and apical pacing groups. The primary endpoint, a combination of all-cause death and hospitalization due to heart failure, was compared between the two groups. RESULTS In the propensity-matched cohort, the primary endpoint was observed in 61 patients (13.7%) over a median follow-up period of 2.1years (interquartile range, 1.1-3.5years). The effects of septal pacing on prognosis were not statistically significant (hazard ratio [HR]=1.10, 95% confidence interval [CI]=0.60-2.04, P=0.752). No significant benefit of septal pacing was observed on all-cause death (HR=1.86, 95%CI=0.74-4.66, P=0.187) and heart failure hospitalization (HR=0.93, 95%CI=0.44-1.98, P=0.847) when assessed separately. CONCLUSION Septal pacing did not show medium-term advantages in prognosis in this large-scale retrospective cohort study with propensity matching of patients with predominantly preserved EF.
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Affiliation(s)
- Akira Mizukami
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.
| | - Yuya Matsue
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Yoshihisa Naruse
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-Ku, Yokohama, Kanagawa 222-0036, Japan
| | - Kenji Kurosaki
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-Ku, Yokohama, Kanagawa 222-0036, Japan
| | - Makoto Suzuki
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Akihiko Matsumura
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Yuji Hashimoto
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
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Biffi M, Bertini M, Saporito D, Belotti G, Quartieri F, Piancastelli M, Pucci A, Boggian G, Mazzocca GF, Giorgi D, Diotallevi P, Diemberger I, Martignani C, Pancaldi S, Ziacchi M, Marcantoni L, Toselli T, Attala S, Iori M, Bottoni N, Argnani S, Tomasi C, Sassone B, Boriani G. Automatic management of atrial and ventricular stimulation in a contemporary unselected population of pacemaker recipients: the ESSENTIAL Registry. Europace 2016; 18:1551-1560. [DOI: 10.1093/europace/euw021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/20/2016] [Indexed: 11/14/2022] Open
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Right ventricular outflow tract septal pacing versus apical pacing: A prospective, randomized, single-blind 5-years follow-up study of ventricular lead performance and safety. ACTA ACUST UNITED AC 2015; 35:858-861. [DOI: 10.1007/s11596-015-1518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 10/29/2015] [Indexed: 10/22/2022]
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9
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Development of mitral and tricuspid regurgitation in right ventricular apex versus right ventricular outflow tract pacing. J Interv Card Electrophysiol 2014; 40:81-6. [DOI: 10.1007/s10840-014-9878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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10
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Elder DHJ, Lang CC, Choy AM. Pacing-induced heart disease: understanding the pathophysiology and improving outcomes. Expert Rev Cardiovasc Ther 2014; 9:877-86. [DOI: 10.1586/erc.11.82] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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PANG BENJAMINJ, JOSHI SUBODHB, LUI ELAINEH, TACEY MARKA, ALISON JEFF, SENEVIRATNE SUJITHK, CAMERON JAMESD, MOND HARRYG. Proximity of Pacemaker and Implantable Cardioverter-Defibrillator Leads to Coronary Arteries as Assessed by Cardiac Computed Tomography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:717-23. [DOI: 10.1111/pace.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/15/2013] [Accepted: 10/20/2013] [Indexed: 01/16/2023]
Affiliation(s)
- BENJAMIN J. PANG
- Department of Cardiology; Royal Melbourne Hospital; Parkville Victoria Australia
- Department of Medicine; University of Melbourne; Victoria Australia
| | - SUBODH B. JOSHI
- Department of Cardiology; Royal Melbourne Hospital; Parkville Victoria Australia
| | - ELAINE H. LUI
- Department of Radiology; Royal Melbourne Hospital & University of Melbourne; Victoria Australia
| | - MARK A. TACEY
- Melbourne EpiCentre; University of Melbourne; Victoria Australia
| | - JEFF ALISON
- Monash Cardiovascular Research Centre; MonashHEART; Melbourne Australia
- Southern Clinical School; Monash University; Melbourne Australia
| | - SUJITH K. SENEVIRATNE
- Monash Cardiovascular Research Centre; MonashHEART; Melbourne Australia
- Southern Clinical School; Monash University; Melbourne Australia
| | - JAMES D. CAMERON
- Monash Cardiovascular Research Centre; MonashHEART; Melbourne Australia
- Southern Clinical School; Monash University; Melbourne Australia
| | - HARRY G. MOND
- Department of Cardiology; Royal Melbourne Hospital; Parkville Victoria Australia
- Department of Medicine; University of Melbourne; Victoria Australia
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Molina L, Sutton R, Gandoy W, Reyes N, Lara S, Limón F, Gómez S, Orihuela C, Salame L, Moreno G. Medium-term effects of septal and apical pacing in pacemaker-dependent patients: a double-blind prospective randomized study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:207-14. [PMID: 23998710 PMCID: PMC4265201 DOI: 10.1111/pace.12257] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/15/2013] [Accepted: 07/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pacing the right ventricle is established practice, but there remains controversy as to the optimal site to preserve hemodynamic function. AIMS To evaluate clinical and hemodynamic differences between apical and septal pacing in pacemaker-dependent patients. METHODS Patients receiving their first pacemaker for advanced atrioventricular block, with the atria in sinus rhythm, were randomized to receive apical (Group A) or septal (Group S) ventricular leads. After implant, with the device programmed VVI 70 beats/min fixed rate, patients underwent a 6-minute walk test and a transthoracic echocardiogram. Then, DDDR was programmed at nominal settings. The same tests were performed at 6 months and 12 months follow-up. If ventricular pacing was less than 98%, the patient was excluded. RESULTS A total of 142 patients were included in the study. During the study year, 71 (50%) were excluded for not fulfilling the condition of 98% ventricular pacing. Groups A and S had 34 and 37 patients, respectively. Age and gender were similar in the groups. At implant, QRS duration was significantly greater in Group A (158 ms) than Group S (146 ms; P = 0.018), and the QRS axis was different: -74.5° in Group A and 1° in Group S (P < 0.001). At 1 year, the 6-minute walk improved significantly in both groups: Group A 15% (P = 0.048) and Group S 24% (P = 0.001). Left ventricular ejection fraction (LVEF) increased from 0.57 to 0.61 (P = 0.008) in Group S, without significant change in Group A. CONCLUSIONS After 1 year, pacemaker-dependent patients with septal ventricular leads have better clinical and functional (LVEF) outcome.
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Affiliation(s)
- Luis Molina
- Arrhythmia Laboratory of the Universidad Nacional Autónoma de México (UNAM) en Hospital General de México, Mexico City, Medico
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Accuracy of Fluoroscopic and Electrocardiographic Criteria for Pacemaker Lead Implantation by Comparison with Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2012; 25:796-803. [DOI: 10.1016/j.echo.2012.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Indexed: 12/20/2022]
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14
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Riahi S, Nielsen JC, Hjortshøj S, Thomsen PEB, Højberg S, Møller M, Dalsgaard D, Nielsen T, Asklund M, Friis EV, Christensen PD, Simonsen EH, Eriksen UH, Jensen GVH, Svendsen JH, Toff WD, Healey JS, Andersen HR. Heart failure in patients with sick sinus syndrome treated with single lead atrial or dual-chamber pacing: no association with pacing mode or right ventricular pacing site. Europace 2012; 14:1475-82. [PMID: 22447958 DOI: 10.1093/europace/eus069] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIMS Previous studies indicate that ventricular pacing may precipitate heart failure (HF). We investigated occurrence of HF during long-term follow-up among patients with sick sinus syndrome (SSS) randomized to AAIR or DDDR pacing. Furthermore, we investigated effects of percentage of ventricular pacing (%VP) and pacing site in the ventricle. METHODS AND RESULTS We analysed data from 1415 patients randomized to AAIR (n = 707) or DDDR pacing (n = 708). Ventricular pacing leads were recorded as located in either an apical or a non-apical position. The %VP and HF hospitalizations were recorded during follow-up. Patients were classified with new HF, if in New York Heart Association (NYHA) functional class IV or if presence of ≥2 of: oedema; dyspnoea; NYHA functional class III. Mean follow-up was 5.4 ± 2.4 years. Heart failure hospitalizations did not differ between groups. In the AAIR group, 170 of the 707 (26%) patients developed HF vs. 169 of the 708 (26%) patients in the DDDR group, hazard rate ratio (HR) 1.00, 95% confidence interval (CI) 0.79-1.22, P = 0.87. In DDDR patients, 146 of the 512 patients (29%) with ventricular leads in an apical position developed HF vs. 28 of the 161 patients (17%) with the leads in a non-apical position, HR 0.67, CI 0.45-1.00, P = 0.05. After adjustments this difference was non-significant. The incidence of HF was not associated with %VP (P = 0.57). CONCLUSION In patients with SSS, HF was not associated with pacing mode, %VP, or ventricular lead localization. This suggests that DDDR pacing is safe in patients with SSS without precipitating HF.
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Affiliation(s)
- Sam Riahi
- Department of Cardiology, Aalborg Hospital, Aalborg University Hospital, Hobrovej 16-18, Postbox 365, DK-9100 Aalborg, Denmark
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Kristiansen H, Hovstad T, Vollan G, Faerestrand S. Right ventricular pacing and sensing function in high posterior septal and apical lead placement in cardiac resynchronization therapy. Indian Pacing Electrophysiol J 2012; 12:4-14. [PMID: 22368376 PMCID: PMC3273951 DOI: 10.1016/s0972-6292(16)30458-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P. METHODS Two hundred and thirty-five consecutive CRT-P patients were included from 1999-2010. Pacing thresholds at 0.5ms and 2.5V, sensing electrograms and lead impedances were measured at implant and repeated 1,3,6,12,18 and 24 months after CRT-P. Electrophysiological measurements of leads located in RV-A and RV-HS were analyzed retrospectively. Bipolar RV leads were used, including high impedance leads, passive fixation and active fixation. RESULTS RV pacing leads were implanted in RV-A (n=79) and RV-HS (n=156). Average RV pacing thresholds from CRT implant procedure to 24-month follow-up at 0.5ms were 0.77±0.69V in RV-A and 0.71±0.35V in RV-HS (P=0.31), and at 2.5V were 0.06±0.08ms in RV-A and 0.07±0.05ms in RV-HS (P=0.12). Average RV electrogram amplitudes from baseline to 24 months after CRT were 15.3±6.9mV in RV-A and 12.1±6.0mV in RV-HS (P=0.55). Average RV impedances during follow-up were 850±286Ω in RV-A and 618±147Ω in RV-HS (P=0.57). Similar RV lead revisions between RV-A and RV-HS were observed after 2-year follow-up (P=0.55). CONCLUSION The RV-HS lead position demonstrated stable and acceptable long-term pacing and sensing function, with rates of complications comparable to conventional RV-A lead position in CRT. The RV-HS lead position is feasible in CRT-P.
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Affiliation(s)
- Hm Kristiansen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Hillock RJ, Mond HG. Pacing the right ventricular outflow tract septum: time to embrace the future. Europace 2011; 14:28-35. [PMID: 21846639 DOI: 10.1093/europace/eur251] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transvenous pacing has revolutionized the management of patients with potentially life-threatening bradycardias and at its most basic level ensures rate support to maintain cardiac output. However, we have known for at least a decade that pacing from the right ventricle (RV) apex can induce left ventricle (LV) dysfunction, atrial fibrillation, heart failure, and maybe an increased mortality. Although pacemaker manufacturers have developed successful pacing algorithms designed to minimize unnecessary ventricular pacing, it cannot be avoided in a substantial proportion of pacemaker-dependent patients. Just as there is undoubted evidence that RV apical pacing is injurious, there is emerging evidence that pacing from the RV septum is associated with a shorter duration of activation, improved haemodynamics, and less LV remodelling. The move from traditional RV apical pacing to RV septal pacing requires a change in mindset for many practitioners. The anatomical landmarks and electrocardiograph features of RV septal pacing are well described and easily recognized. While active fixation is required to place the lead on the septum, shaped stylets are now available to assist the implanter. In addition, concerns about the stability and longevity of steroid-eluting active fixation leads have proven to be unfounded. We therefore encourage all implanters to adopt RV septal pacing to minimize the potential of harm to their patients.
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Affiliation(s)
- Richard J Hillock
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, Australia
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Modi S, Krahn A, Yee R. Current concepts in pacing 2010-2011: the right and wrong way to pace. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:370-84. [PMID: 21710197 DOI: 10.1007/s11936-011-0137-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OPINION STATEMENT Over five decades have passed since the first permanent cardiac pacemakers were introduced into clinical medicine. Evolving technology and falling costs have demanded adaptation to clinical practice and implantation trends and, with the advent of evidenced-based medicine, the specific roles and benefits of individual pacemaker technologies have never been so carefully scrutinized. Pacing mode choice continues to be a subject of great controversy, and there are great regional variations in practice. We believe that single chamber atrial pacing use (AAI/R) has become an anachronism that should generally be abandoned (obviously with rare exceptional cases) and be replaced by dual chamber pacemakers (DDD/R) equipped with modern pacing algorithms that minimize patient exposure to ventricular pacing. Also, in patients with atrioventricular (AV) block, randomized clinical trials have failed to show improvement in clinically relevant outcomes such as mortality, stroke, and heart failure, particularly in the elderly, which has led some to advocate that DDD/R devices should never be offered to elderly AV block patients. However, we believe that the elderly, like the young, come in many "shapes and sizes" and individualized medicine compels us to consider each pacemaker candidate as unique. Implanting DDD/R devices in chronologically older, yet physiologically younger, patients is justifiable and good medical practice. Where right ventricular (RV) pacing is necessary and unavoidable, physicians should consider routinely placing RV leads on the RV mid- or outflow tract septum because these location are as good, if not better, for patients than the current practice of RV apical lead placement. In patients with AV block and asymptomatic yet moderate to severely depressed left ventricular systolic function, primary cardiac resynchronization therapy (CRT) should be strongly considered. Compelling clinical trial evidence does not yet exist to indicate that CRT should be the standard of care in patients with AV block and intact left ventricular systolic function. Right ventricular septal lead placement remains a reasonable option.
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Affiliation(s)
- Simon Modi
- Arrhythmia Service, London Health Sciences Centre, London, ON, Canada,
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Right ventricular septal pacing. COR ET VASA 2011. [DOI: 10.33678/cor.2011.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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MOND HARRYG, FELDMAN ALEXANDER, KUMAR SAURABH, ROSSO RAPHAEL, HUNG THUYTO, PANG BEN. Alternate Site Right Ventricular Pacing: Defining Template Scoring. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1080-6. [DOI: 10.1111/j.1540-8159.2011.03129.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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BIFFI MAURO, MARTIGNANI CRISTIAN, BORIANI GIUSEPPE. Response:. Pacing Clin Electrophysiol 2011. [DOI: 10.1111/j.1540-8159.2010.03008.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Biffi M, Bertini M, Mazzotti A, Gardini B, Mantovani V, Ziacchi M, Valzania C, Martignani C, Diemberger I, Boriani G. Long-term RV threshold behavior by automated measurements: safety is the standpoint of pacemaker longevity! PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:89-95. [PMID: 21029120 DOI: 10.1111/j.1540-8159.2010.02915.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We studied long-term right ventricular (RV) pacing threshold (RVPT) behavior in patients consecutively implanted with pacemakers capable of automatic output reprogramming tracked by automatic RV threshold measurement (automatic verification of capture [AVC]). METHODS All the patients had state-of-the art steroid-eluting bipolar pacing leads and were RV-paced by an AVC algorithm from the three American manufacturers. Follow-up occurred twice in the first year after implantation, then yearly until approaching elective replacement indicator. RESULTS Three hundred and twenty-one patients aged 73 ± 12 years were observed for 49 ± 26 months on average. At implantation, RVPT was 0.54 ± 0.2 V at 0.4 ms at an average 774 ± 217 Ω impedance. Forty-one of the 321 patients (12.8%) had a permanent RVPT increase above 1.5 V at 0.4 ms: RVPT was between 1.6 and 2.5 V in 29 of 321 (9%) patients, whereas it was between 2.6 and 3.5 V in seven of 321 (2.2%) patients, and >3.5 V in five of 321 (1.5%) patients. No exit block occurred because of automatic RV output adjustment by AVC algorithms. No predictor of RVPT increase was found at multivariable analysis. The maximum RVPT increase occurred within 12 months from implantation in 19 of 321 (5.9%) patients, between the first and the second year in 12 of 321 (3.7%), between the second and the sixth year in eight of 321 (2.5%), and after the sixth year in two of 321 (0.6%). CONCLUSION Despite technologic improvement in lead manufacturing, long-term increase of the RVPT occurs in about 13% of patients, possibly representing a serious safety issue in 3.7% when 2.5 V at 0.4 ms is exceeded. AVC algorithms can improve patients' safety by automatic tailoring of the pacing output to threshold fluctuations, while maximizing device longevity.
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Affiliation(s)
- Mauro Biffi
- S.Orsola-Malpighi Hospital, Institute of Cardiology, University of Bologna, Bologna, Italy.
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MOND HARRYG, VLAY STEPHENC. Pacing the Right Ventricular Septum: Time to Abandon Apical Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1293-7. [DOI: 10.1111/j.1540-8159.2010.02876.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MOND HARRYG. The Road to Right Ventricular Septal Pacing: Techniques and Tools. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:888-98. [DOI: 10.1111/j.1540-8159.2010.02777.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sancho-Tello de Carranza MJ, Martínez-Ferrer J, Pombo-Jiménez M, de Juan-Montiel J. [Progress in cardiac pacing]. Rev Esp Cardiol 2010; 63 Suppl 1:73-85. [PMID: 20223181 DOI: 10.1016/s0300-8932(10)70142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review discusses the utility and current status of remote monitoring in patients with cardiac devices in Spain, the different anticoagulation strategies used during device implantation, the surgical replacement and maintenance of pacemakers and defibrillators, and the present and future importance of impedance sensors in cardiac pacing and heart failure management. Finally, there is a summary of the most relevant scientific articles published in the last year.
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ROSSO RAPHAEL, TEH ANDREWW, MEDI CAROLINE, HUNG THUYTO, BALASUBRAMANIAM RICHARD, MOND HARRYG. Right Ventricular Septal Pacing: The Success of Stylet-Driven Active-Fixation Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:49-53. [DOI: 10.1111/j.1540-8159.2009.02580.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Paul A. Levine
- Corresponding author. Tel: +1 818 493 2900, Fax: +1 818 362 2242,
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