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Russo V, Tomaino M, Parente E, Comune A, Giacopelli D, Napoli P, Gargaro A, Brignole M. Temporal relationship between haemodynamic changes and activation of closed-loop stimulation during a tilt-induced vasovagal syncope. Europace 2024; 26:euae045. [PMID: 38340330 PMCID: PMC10886438 DOI: 10.1093/europace/euae045] [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: 12/08/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
AIMS A dual-chamber pacemaker with closed-loop stimulation (CLS) mode is effective in reducing syncopal recurrences in patients with asystolic vasovagal syncope (VVS). In this study, we explored the haemodynamic and temporal relationship of CLS during a tilt-induced vasovagal reflex. METHODS AND RESULTS Twenty patients underwent a tilt test under video recording 3.9 years after CLS pacemaker implantation. Three patients were excluded from the analysis because of no VVS induced by the tilt test (n = 1) and protocol violation (n = 2). In 14 of the remaining 17 patients, CLS pacing emerged during the pre-syncopal phase of circulatory instability when the mean intrinsic heart rate (HR) was 88 ± 12 b.p.m. and systolic blood pressure (SBP) was 108 ± 19 mmHg. The CLS pacing rate thereafter rapidly increased to 105 ± 14 b.p.m. within a median of 0.1 min [inter-quartile range (IQR), 0.1-0.7 min] when the SBP was 99 ± 21 mmHg. At the time of maximum vasovagal effect (syncope or pre-syncope), SBP was 63 ± 17 mmHg and the CLS rate was 95 ± 13 b.p.m. The onset of CLS pacing was 1.7 min (IQR, 1.5-3.4) before syncope or lowest SBP. The total duration of CLS pacing was 5.0 min (IQR, 3.3-8.3). Closed-loop stimulation pacing was not observed in three patients who had a similar SBP decrease from 142 ± 22 mmHg at baseline to 69 ± 4 mmHg at the time of maximum vasovagal effect, but there was no significant increase in HR (59 ± 1 b.p.m.). CONCLUSION The reproducibility of a vasovagal reflex was high. High-rate CLS pacing was observed early during the pre-syncopal phase in most patients and persisted, although attenuated, at the time of maximum vasovagal effect. REGISTRATION ClinicalTrials.gov identifier: NCT06038708.
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Affiliation(s)
- Vincenzo Russo
- Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’—Monaldi Hospital, 80126 Naples, Italy
| | - Marco Tomaino
- Department of Cardiology, Ospedale Generale Regionale, Bolzano, Italy
| | - Erika Parente
- Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’—Monaldi Hospital, 80126 Naples, Italy
| | - Angelo Comune
- Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’—Monaldi Hospital, 80126 Naples, Italy
| | | | - Paola Napoli
- Research Clinical Unit, Biotronik Italy, Milan, Italy
| | | | - Michele Brignole
- IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Department of Cardiology, S. Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
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Chua SK, Chen WL, Chen LC, Shyu KG, Hung HF, Lee SH, Wang TL, Lai WT, Chen KJ, Liao ZY, Chuang CY, Chou CY. Enhancement of bicycle exercise capacity in patients with chronotropic incompetence through closed-loop stimulation: a randomized crossover trial. Europace 2023; 25:euad358. [PMID: 38042981 PMCID: PMC10751807 DOI: 10.1093/europace/euad358] [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: 10/15/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
AIMS This study aimed to investigate the effectiveness of closed-loop stimulation (CLS) pacing compared with the traditional DDD mode in patients with chronotropic incompetence (CI) using bicycle-based cardiopulmonary exercise testing (CPET). METHODS AND RESULTS This single-centre, randomized crossover trial involved 40 patients with CI. Patients were randomized to receive either DDD-CLS or DDD mode pacing for 2 months, followed by a crossover to the alternative mode for an additional 2 months. Bicycling-based CPET was conducted at the 3- and 5-month follow-up visits to assess exercise capacity. Other cardiopulmonary exercise outcome measures and health-related quality of life (QoL) were also assessed. DDD-CLS mode pacing significantly improved exercise capacity, resulting in a peak oxygen uptake (14.8 ± 4.0 vs. 12.0 ± 3.6 mL/kg/min, P < 0.001) and oxygen uptake at the ventilatory threshold (10.0 ± 2.2 vs. 8.7 ± 1.8 mL/kg/min, P < 0.001) higher than those of the DDD mode. However, there were no significant differences in other cardiopulmonary exercise outcome measures such as ventilatory efficiency of carbon dioxide production slope, oxygen uptake efficiency slope, and end-tidal carbon dioxide between the two modes. Patients in the DDD-CLS group reported a better QoL, and 97.5% expressed a preference for the DDD-CLS mode. CONCLUSION DDD-CLS mode pacing demonstrated improved exercise capacity and QoL in patients with CI, highlighting its potential as an effective pacing strategy for this patient population.
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Affiliation(s)
- Su-Kiat Chua
- School of Medicine, College of Medicine, Fu Jen Catholic University, 510 Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Wen-Ling Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, 510 Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Lung-Ching Chen
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Kou-Gi Shyu
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Huei-Fong Hung
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Shih-Huang Lee
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Tzu-Lin Wang
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Wei-Ting Lai
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Kuan-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Zhen-Yu Liao
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Cheng-Yen Chuang
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Ching-Yao Chou
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
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3
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Dutta A, Cheng H. Pathway of transient electronics towards connected biomedical applications. NANOSCALE 2023; 15:4236-4249. [PMID: 36688506 DOI: 10.1039/d2nr06068j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Transient electronic devices have shown promising applications in hardware security and medical implants with diagnosing therapeutics capabilities since their inception. Control of the device transience allows the device to "dissolve at will" after its functional operation, leading to the development of on-demand transient electronics. This review discusses the recent developments and advantages of triggering strategies (e.g., electrical, thermal, ultrasound, and optical) for controlling the degradation of on-demand transient electronics. We also summarize bioresorbable sensors for medical diagnoses, including representative applications in electrophysiology and neurochemical sensing. Along with the profound advancements in medical diagnosis, the commencement of therapeutic systems such as electrical stimulation and drug delivery for the biomedical or medical implant community has also been discussed. However, implementing a transient electronic system in real healthcare infrastructure is still in its infancy. Many critical challenges still need to be addressed, including strategies to decouple multimodal sensing signals, dissolution selectivity in the presence of multiple stimuli, and a complete sensing-stimulation closed-loop system. Therefore, the review discusses future opportunities in transient decoupling sensors and robust transient devices, which are selective to a particular stimulus and act as hardware-based passwords. Recent advancements in closed-loop controller-enabled electronics have also been analyzed for future opportunities of using data-driven artificial intelligence-powered controllers in fully closed-loop transient systems.
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Affiliation(s)
- Ankan Dutta
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, 16802, USA.
| | - Huanyu Cheng
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, 16802, USA.
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Świerżyńska E, Oręziak A, Główczyńska R, Rossillo A, Grabowski M, Szumowski Ł, Caprioglio F, Sterliński M. Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23031427. [PMID: 36772467 PMCID: PMC9920425 DOI: 10.3390/s23031427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 05/12/2023]
Abstract
Modern cardiac pacemakers are equipped with a function that allows the heart rate to adapt to the current needs of the patient in situations of increased demand related to exercise and stress ("rate-response" function). This function may be based on a variety of mechanisms, such as a built-in accelerometer responding to increased chest movement or algorithms sensing metabolic demand for oxygen, analysis of intrathoracic impedance, and analysis of the heart rhythm (Q-T interval). The latest technologies in the field of rate-response functionality relate to the use of an accelerometer in leadless endocavitary pacemakers; in these devices, the accelerometer enables mapping of the mechanical wave of the heart's work cycle, enabling the pacemaker to correctly sense native impulses and stimulate the ventricles in synchrony with the cycles of atria and heart valves. Another modern system for synchronizing pacing rate with the patient's real-time needs requires a closed-loop system that continuously monitors changes in the dynamics of heart contractions. This article discusses the technical details of various solutions for detecting and responding to situations related to increased oxygen demand (e.g., exercise or stress) in implantable pacemakers, and reviews the results of clinical trials regarding the use of these algorithms.
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Affiliation(s)
- Ewa Świerżyńska
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence:
| | - Artur Oręziak
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Renata Główczyńska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Antonio Rossillo
- Department of Cardiology, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Łukasz Szumowski
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | | | - Maciej Sterliński
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
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5
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Relationships among norepinephrine levels, exercise capacity, and chronotropic responses in heart failure patients. Heart Fail Rev 2023; 28:35-45. [PMID: 35325323 DOI: 10.1007/s10741-022-10232-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
In heart failure (HF) patients, the pathophysiological mechanisms of severe exercise intolerance and impaired exercise capacity are related to both central and peripheral abnormalities. The central abnormalities in HF patients include impaired cardiac function and chronotropic incompetence (CI). Indeed, CI, the inability to adequately increase heart rate (HR) from rest to exercise often exhibited by HF patients, is related to activation of the sympathetic nervous system (SNS) yielding a rise in circulating norepinephrine (NE). CI may result from downregulation of β-adrenergic receptors, β-blocker usage, high baseline HR, or due to a combination of factors. This paper discusses the role of elevated NE in altering chronotropic responses in HF patients and consequently resulting in impaired exercise capacity. We suggest that future research should focus on the potential treatment of CI with rate-adaptive pacing, using a sensor to measure physical activity, without inducing deleterious hormonal activation of the sympathetic system.
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6
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Morillo CA, Brignole M. Pacing for vasovagal syncope: Tips for use in practice. Auton Neurosci 2022; 241:102998. [DOI: 10.1016/j.autneu.2022.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
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7
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Choi YS, Jeong H, Yin RT, Avila R, Pfenniger A, Yoo J, Lee JY, Tzavelis A, Lee YJ, Chen SW, Knight HS, Kim S, Ahn HY, Wickerson G, Vázquez-Guardado A, Higbee-Dempsey E, Russo BA, Napolitano MA, Holleran TJ, Razzak LA, Miniovich AN, Lee G, Geist B, Kim B, Han S, Brennan JA, Aras K, Kwak SS, Kim J, Waters EA, Yang X, Burrell A, Chun KS, Liu C, Wu C, Rwei AY, Spann AN, Banks A, Johnson D, Zhang ZJ, Haney CR, Jin SH, Sahakian AV, Huang Y, Trachiotis GD, Knight BP, Arora RK, Efimov IR, Rogers JA. A transient, closed-loop network of wireless, body-integrated devices for autonomous electrotherapy. Science 2022; 376:1006-1012. [PMID: 35617386 PMCID: PMC9282941 DOI: 10.1126/science.abm1703] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Temporary postoperative cardiac pacing requires devices with percutaneous leads and external wired power and control systems. This hardware introduces risks for infection, limitations on patient mobility, and requirements for surgical extraction procedures. Bioresorbable pacemakers mitigate some of these disadvantages, but they demand pairing with external, wired systems and secondary mechanisms for control. We present a transient closed-loop system that combines a time-synchronized, wireless network of skin-integrated devices with an advanced bioresorbable pacemaker to control cardiac rhythms, track cardiopulmonary status, provide multihaptic feedback, and enable transient operation with minimal patient burden. The result provides a range of autonomous, rate-adaptive cardiac pacing capabilities, as demonstrated in rat, canine, and human heart studies. This work establishes an engineering framework for closed-loop temporary electrotherapy using wirelessly linked, body-integrated bioelectronic devices.
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Affiliation(s)
- Yeon Sik Choi
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Precision Biology Research Center, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Hyoyoung Jeong
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Rose T. Yin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Anna Pfenniger
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Jaeyoung Yoo
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL, 60714, USA
| | - Andreas Tzavelis
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Medical Scientist Training Program, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Young Joong Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Sheena W. Chen
- Department of General Surgery, The George Washington University, Washington, DC 20052, USA
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Helen S. Knight
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Seungyeob Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Electronic Engineering, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, 406-772, Republic of Korea
| | - Hak-Young Ahn
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Precision Biology Research Center, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Grace Wickerson
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Abraham Vázquez-Guardado
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Bender A. Russo
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Michael A. Napolitano
- Department of General Surgery, The George Washington University, Washington, DC 20052, USA
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Timothy J. Holleran
- Department of General Surgery, The George Washington University, Washington, DC 20052, USA
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Leen Abdul Razzak
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Alana N. Miniovich
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Geumbee Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Beth Geist
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | | | - Shuling Han
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jaclyn A. Brennan
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Kedar Aras
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Sung Soo Kwak
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Current Address: Center for Bionics of Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Korea
| | - Joohee Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Emily Alexandria Waters
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL 60208, USA
| | - Xiangxing Yang
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Tx, 78712, USA
| | - Amy Burrell
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Keum San Chun
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Tx, 78712, USA
| | - Claire Liu
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Changsheng Wu
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Alina Y. Rwei
- Department of Chemical Engineering, Delft University of Technology, Van der Maasweg 9, 2629 HZ Delft, The Netherlands
| | - Alisha N. Spann
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL 60208, USA
| | - Anthony Banks
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - David Johnson
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Zheng Jenny Zhang
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Chad R. Haney
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL 60208, USA
| | - Sung Hun Jin
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Electronic Engineering, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, 406-772, Republic of Korea
| | - Alan Varteres Sahakian
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Gregory D. Trachiotis
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Bradley P. Knight
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Rishi K. Arora
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Igor R. Efimov
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - John A. Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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8
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [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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9
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Marinaccio L, Giacopelli D, Ginocchio G, Vetta F, Marchese D. Closed loop stimulation with His bundle lead placement. J Cardiol Cases 2022; 26:126-129. [DOI: 10.1016/j.jccase.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
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10
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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12
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Tomaino M, Russo V, Giacopelli D, Gargaro A, Brignole M. Cardiac Pacing in Cardioinhibitory Reflex Syncope: Clinical Use of Closed-loop Stimulation. Arrhythm Electrophysiol Rev 2021; 10:244-249. [PMID: 35106176 PMCID: PMC8785081 DOI: 10.15420/aer.2021.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiac pacing has been studied extensively in patients with reflex syncope over the past two decades. The heterogeneity of the forms and clinical manifestations of reflex syncope explain the controversial results of older randomised clinical trials. New evidence from recent trials has changed medical practice, now leading to clear indications for pacing in patients with asystolic syncope documented during carotid sinus massage, implantable cardiac monitoring or tilt testing. Given that recent trials in reflex syncope have been performed using the closed-loop stimulation algorithm, the authors will briefly discuss this pacing mode, review hypotheses about the mechanisms underlying its activation during syncope and provide practical instructions for programming and troubleshooting.
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Affiliation(s)
| | - Vincenzo Russo
- Department of Cardiology, University of Campania ‘Luigi Vanvitelli’, Ospedale Monaldi, Naples, Italy
| | | | | | - Michele Brignole
- IRCCS Istituto Auxologico Italiano, Faint and Fall Programme, Ospedale San Luca, Milano, Italy
- Arrhythmology Centre and Syncope Unit, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
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13
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 807] [Impact Index Per Article: 269.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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14
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Lyu Q, Gong S, Yin J, Dyson JM, Cheng W. Soft Wearable Healthcare Materials and Devices. Adv Healthc Mater 2021; 10:e2100577. [PMID: 34019737 DOI: 10.1002/adhm.202100577] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/25/2021] [Indexed: 12/16/2022]
Abstract
In spite of advances in electronics and internet technologies, current healthcare remains hospital-centred. Disruptive technologies are required to translate state-of-art wearable devices into next-generation patient-centered diagnosis and therapy. In this review, recent advances in the emerging field of soft wearable materials and devices are summarized. A prerequisite for such future healthcare devices is the need of novel materials to be mechanically compliant, electrically conductive, and biologically compatible. It is begun with an overview of the two viable design strategies reported in the literatures, which is followed by description of state-of-the-art wearable healthcare devices for monitoring physical, electrophysiological, chemical, and biological signals. Self-powered wearable bioenergy devices are also covered and sensing systems, as well as feedback-controlled wearable closed-loop biodiagnostic and therapy systems. Finally, it is concluded with an overall summary and future perspective.
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Affiliation(s)
- Quanxia Lyu
- Department of Chemical Engineering Monash University Clayton VIC 3800 Australia
| | - Shu Gong
- Department of Chemical Engineering Monash University Clayton VIC 3800 Australia
| | - Jialiang Yin
- Department of Chemical Engineering Monash University Clayton VIC 3800 Australia
| | - Jennifer M. Dyson
- Department of Biochemistry & Molecular Biology Biomedicine Discovery Institute Clayton VIC 3800 Australia
- Faculty of Engineering Monash Institute of Medical Engineering (MIME) Monash University Clayton VIC 3800 Australia
| | - Wenlong Cheng
- Department of Chemical Engineering Monash University Clayton VIC 3800 Australia
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15
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Brignole M, Russo V, Arabia F, Oliveira M, Pedrote A, Aerts A, Rapacciuolo A, Boveda S, Deharo JC, Maglia G, Nigro G, Giacopelli D, Gargaro A, Tomaino M. Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole. Eur Heart J 2021; 42:508-516. [PMID: 33279955 PMCID: PMC7857694 DOI: 10.1093/eurheartj/ehaa936] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/26/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Aim The benefit of cardiac pacing in patients with severe recurrent reflex syncope and asystole induced by tilt testing has not been established. The usefulness of tilt-table test to select candidates for cardiac pacing is controversial. Methods and results We randomly assigned patients aged 40 years or older who had at least two episodes of unpredictable severe reflex syncope during the last year and a tilt-induced syncope with an asystolic pause longer than 3 s, to receive either an active (pacing ON; 63 patients) or an inactive (pacing OFF; 64 patients) dual-chamber pacemaker with closed loop stimulation (CLS). The primary endpoint was the time to first recurrence of syncope. Patients and independent outcome assessors were blinded to the assigned treatment. After a median follow-up of 11.2 months, syncope occurred in significantly fewer patients in the pacing group than in the control group [10 (16%) vs. 34 (53%); hazard ratio, 0.23; P = 0.00005]. The estimated syncope recurrence rate at 1 year was 19% (pacing) and 53% (control) and at 2 years, 22% (pacing) and 68% (control). A combined endpoint of syncope or presyncope occurred in significantly fewer patients in the pacing group [23 (37%) vs. 40 (63%); hazard ratio, 0.44; P = 0.002]. Minor device-related adverse events were reported in five patients (4%). Conclusion In patients aged 40 years or older, affected by severe recurrent reflex syncope and tilt-induced asystole, dual-chamber pacemaker with CLS is highly effective in reducing the recurrences of syncope. Our findings support the inclusion of tilt testing as a useful method to select candidates for cardiac pacing. Study registration ClinicalTrials.gov identifier NCT02324920, Eudamed number CIV-05-013546.
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Affiliation(s)
- Michele Brignole
- Department of Cardiovascular, Neural and Metabolic Sciences, Faint & Fall Programme, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Piazzale Brescia 20, Milano 20149, Italy.,Department of Cardiology, Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, via don Bobbio 24, 16033 Lavagna, Italy
| | - Vincenzo Russo
- Department of Cardiology, Chair of Cardiology, University of the Study of Campania "Luigi Vanvitelli", Ospedale Monaldi, Via leonardo Bianchi, 80131 Napoli, Italy
| | - Francesco Arabia
- Department of Cardiology, Unit of Arrhythmology, A.O. Pugliese-Ciaccio, Viale Papa Pio X, 83, 88100 Castanzaro, Italy
| | - Mario Oliveira
- Cardiology Department, Santa Marta Hospital-University Central Hospital of Lisbon, Rue de Santa Marta, 50, 1150-140 Lisboa, Portugal
| | - Alonso Pedrote
- Division of Arrhythmology, Virgen del Rocio University Hospital, Avenida Manuel Siurot, 40013 Sevilla, Spain
| | - Arnaud Aerts
- Department of Cardiology, Zuyderland Medisch Centrum, Henri Dunantstraat, 5 6419PC Heerlen, The Netherlands
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, via Sergio Pansini 5, 80100 Napoli, Italy
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 45 avenue de Lombez - BP 27617 - 31076 Toulouse Cedex 3, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Laarbeeklaan 101 1090 Brussels, Belgium
| | - Jean Claude Deharo
- Department of Cardiology, Hôpital La Timone Adultes, 264 Rue Saint-Pierre 13385 Marseille Cedex 5, France
| | - Giampiero Maglia
- Department of Cardiology, Unit of Arrhythmology, A.O. Pugliese-Ciaccio, Viale Papa Pio X, 83, 88100 Castanzaro, Italy
| | - Gerardo Nigro
- Department of Cardiology, Chair of Cardiology, University of the Study of Campania "Luigi Vanvitelli", Ospedale Monaldi, Via leonardo Bianchi, 80131 Napoli, Italy
| | - Daniele Giacopelli
- Research Clinical Unit, Biotronik Italy, Via delle Industrie, 11 20090 Vimodrone (MI), Italy
| | - Alessio Gargaro
- Research Clinical Unit, Biotronik Italy, Via delle Industrie, 11 20090 Vimodrone (MI), Italy
| | - Marco Tomaino
- Department of Cardiology, Ospedale Generale Regionale, Via Lorenz Böhler 5 39100 Bolzano, Italy
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16
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Joo H, Lee Y, Kim J, Yoo JS, Yoo S, Kim S, Arya AK, Kim S, Choi SH, Lu N, Lee HS, Kim S, Lee ST, Kim DH. Soft implantable drug delivery device integrated wirelessly with wearable devices to treat fatal seizures. SCIENCE ADVANCES 2021; 7:7/1/eabd4639. [PMID: 33523849 PMCID: PMC7775752 DOI: 10.1126/sciadv.abd4639] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/11/2020] [Indexed: 05/20/2023]
Abstract
Personalized biomedical devices have enormous potential to solve clinical challenges in urgent medical situations. Despite this potential, a device for in situ treatment of fatal seizures using pharmaceutical methods has not been developed yet. Here, we present a novel treatment system for neurological medical emergencies, such as status epilepticus, a fatal epileptic condition that requires immediate treatment, using a soft implantable drug delivery device (SID). The SID is integrated wirelessly with wearable devices for monitoring electroencephalography signals and triggering subcutaneous drug release through wireless voltage induction. Because of the wireless integration, bulky rigid components such as sensors, batteries, and electronic circuits can be moved from the SID to wearables, and thus, the mechanical softness and miniaturization of the SID are achieved. The efficacy of the prompt treatment could be demonstrated with animal experiments in vivo, in which brain damages were reduced and survival rates were increased.
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Affiliation(s)
- Hyunwoo Joo
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Youngsik Lee
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jaemin Kim
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jeong-Suk Yoo
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Seungwon Yoo
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Sangyeon Kim
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Ashwini Kumar Arya
- Department of Electronic Engineering, Kyung Hee University, Yongin-si 17104, Republic of Korea
- Institute for Wearable Convergence Electronics, Kyung Hee University, Yongin-si 17104, Republic of Korea
| | - Sangjun Kim
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Seung Hong Choi
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Nanshu Lu
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX 78712, USA
- Department of Aerospace Engineering and Engineering Mechanics, Center for Mechanics of Solids, Structures and Materials, University of Texas at Austin, Austin, TX 78712, USA
- Department of Biomedical Engineering, Texas Materials Institute, University of Texas at Austin, Austin, TX 78712, USA
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sanghoek Kim
- Department of Electronic Engineering, Kyung Hee University, Yongin-si 17104, Republic of Korea.
- Institute for Wearable Convergence Electronics, Kyung Hee University, Yongin-si 17104, Republic of Korea
- Department of Electronics and Information Convergence Engineering, Kyung Hee University, Yongin-si 17104, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Republic of Korea.
| | - Dae-Hyeong Kim
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul 08826, Republic of Korea.
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
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17
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Noessler N, Koestenberger M, Kurath-Koller S. Atrial auto-short phenomenon as a rare cause of ventricular lead failure in a pediatric dual chamber pacemaker patient. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:353-356. [PMID: 32031265 PMCID: PMC7155012 DOI: 10.1111/pace.13880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nathalie Noessler
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
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18
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Ikeya Y, Nakai T, Murata N, Monden M, Ogaku A, Hori K, Watanabe R, Arai M, Okumura Y. Effective Pacing Intervention by Closed-loop Stimulation Using a Coronary Vein Lead in a Post-tricuspid Valve Replacement Patient. Intern Med 2020; 59:963-966. [PMID: 32238662 PMCID: PMC7184078 DOI: 10.2169/internalmedicine.4018-19] [Citation(s) in RCA: 2] [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] [Indexed: 11/06/2022] Open
Abstract
To avoid the negative effects associated with pacing, pacemakers are designed to achieve a pacing cadence as close to physiological pacing as possible. In closed-loop stimulation (CLS; a type of rate-responsive functionality used in pacemakers), the changes in impedance (which correlates with the contractility of the myocardium around the lead tip electrode) are tracked, and the paced heart rate is adjusted accordingly. We herein report a case in which we implanted a pacemaker in a post-tricuspid valve replacement patient. A ventricular lead positioned in the coronary vein exhibited good CLS functionality, and the patient's dizziness and heart failure improved.
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Affiliation(s)
- Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Masaki Monden
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Akihito Ogaku
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Koichiro Hori
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
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19
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Cronin B, Dalia A, Sandoval K, Birgersdotter-Green U, Sherer E, Essandoh MK. Perioperative Interrogation of Biotronik Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2019; 33:3427-3436. [DOI: 10.1053/j.jvca.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 11/11/2022]
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20
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Silvetti MS, Pazzano V, Battipaglia I, Di Mambro C, Calvieri C, Saputo FA, Verticelli L, Carotti A, Torcinaro S, Drago F. Physiological pacing in young patients with complex congenital heart defects. Pacing Clin Electrophysiol 2018; 41:967-977. [PMID: 29873818 DOI: 10.1111/pace.13409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/27/2018] [Accepted: 05/28/2018] [Indexed: 12/01/2022]
Abstract
AIM Young patients with operated complex congenital heart defects (CHD) often develop sinus node dysfunction (SND) requiring permanent pacing with rate-responsive function. Activity-driven sensors cannot account for nonmovement stress and cannot modulate heart rate physiologically. Closed Loop Stimulation (CLS, Biotronik, Berlin, Germany) is a physiological rate-responsive pacemaker based on the indirect measure of ventricular contractility. No data are available on the effects of such pacing strategy in young patients. METHODS We report a series of nine patients with CHD and SND who underwent single-chamber CLS-atrial pacing with endocardial or epicardial lead. During the first 30 days, the pacemaker was programmed in AAI pacing mode and then was switched to CLS-atrial pacing mode. An in-hospital control was scheduled 1-2 months later to evaluate the CLS response to neurovegetative stresses (i.e., nonmovement stress [Stroop color test, handgrip] and exercise stress test) and Holter monitor. CLS pacing was compared with rate-responsive accelerometer-driven pacing (AAIR). RESULTS At telemetric interrogation, CLS pacing showed a more physiological pattern of 24-h heart rate trends than accelerometer sensors. The data obtained during nonmovement/exercise stress demonstrated a physiological increase in the pacing rate with CLS, in synergy with spontaneous events. The accelerometer sensor histogram, during nonmovement stress, showed a "nonresponse" behavior (only lower rate events), and during exercise test showed most events in lower rate range. Holter monitoring showed increase of average and maximum heart rate compared with AAIR. CONCLUSION In young CHD patients, endocardial/epicardial CLS-atrial pacing demonstrated a physiological response of heart rate to neurovegetative and physical stresses.
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Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Vincenzo Pazzano
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Irma Battipaglia
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Corrado Di Mambro
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Camilla Calvieri
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Letizia Verticelli
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Adriano Carotti
- Heart Surgery Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | | | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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21
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Chinushi M, Tachikawa H, Chinushi Y, Yamaguchi T, Saitoh O, Tsuda T. Incorrect Holter-ECG analysis caused by the pacemaker delivering small high-frequency currents for thoracic impedance measurement. J Cardiol Cases 2017; 16:219-222. [DOI: 10.1016/j.jccase.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022] Open
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22
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Shortland J, Uzun O, Wilson D, Stuart GA, Walsh MA. Use of Biotronik closed loop pacemaker to treat recurrent syncope in pediatric patient with dysautonomia. HeartRhythm Case Rep 2016; 3:27-29. [PMID: 28491761 PMCID: PMC5420039 DOI: 10.1016/j.hrcr.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jennifer Shortland
- Bristol Royal Hospital for Children, Bristol, United Kingdom.,University Hospital of Wales, Cardiff, United Kingdom
| | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | - Deirdre Wilson
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Graham A Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom.,Bristol Heart Institute, Bristol, United Kingdom
| | - Mark A Walsh
- Bristol Royal Hospital for Children, Bristol, United Kingdom.,Bristol Heart Institute, Bristol, United Kingdom
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23
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Dadlani V, Levine JA, McCrady-Spitzer SK, Dassau E, Kudva YC. Physical Activity Capture Technology With Potential for Incorporation Into Closed-Loop Control for Type 1 Diabetes. J Diabetes Sci Technol 2015; 9:1208-16. [PMID: 26481641 PMCID: PMC4667300 DOI: 10.1177/1932296815609949] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Physical activity is an important determinant of glucose variability in type 1 diabetes (T1D). It has been incorporated as a nonglucose input into closed-loop control (CLC) protocols for T1D during the last 4 years mainly by 3 research groups in single center based controlled clinical trials involving a maximum of 18 subjects in any 1 study. Although physical activity data capture may have clinical benefit in patients with T1D by impacting cardiovascular fitness and optimal body weight achievement and maintenance, limited number of such studies have been conducted to date. Clinical trial registries provide information about a single small sample size 2 center prospective study incorporating physical activity data input to modulate closed-loop control in T1D that are seeking to build on prior studies. We expect an increase in such studies especially since the NIH has expanded support of this type of research with additional grants starting in the second half of 2015. Studies (1) involving patients with other disorders that have lasted 12 weeks or longer and tracked physical activity and (2) including both aerobic and resistance activity may offer insights about the user experience and device optimization even as single input CLC heads into real-world clinical trials over the next few years and nonglucose input is introduced as the next advance.
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Affiliation(s)
- Vikash Dadlani
- Endocrine Research Unit, Mayo Clinic, Rochester, MN, USA
| | - James A Levine
- Mayo Clinic, Scottsdale, AZ, USA Obesity Solutions, Mayo Clinic Arizona and Arizona State University, Tempe, AZ, USA
| | | | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - Yogish C Kudva
- Endocrine Research Unit, Mayo Clinic, Rochester, MN, USA
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24
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Ginsberg JP, Pietrabissa G, Manzoni GM, Castelnuovo G. Treating the mind to improve the heart: the summon to cardiac psychology. Front Psychol 2015; 6:1101. [PMID: 26300804 PMCID: PMC4523709 DOI: 10.3389/fpsyg.2015.01101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/17/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- J P Ginsberg
- Research and Development, Cardiopsychology Research Laboratory, Dorn VA Medical Center Columbia, SC, USA
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan Italy
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Banchs JE, Scher DL. Emerging role of digital technology and remote monitoring in the care of cardiac patients. Med Clin North Am 2015; 99:877-96. [PMID: 26042888 DOI: 10.1016/j.mcna.2015.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Current available mobile health technologies make possible earlier diagnosis and long-term monitoring of patients with cardiovascular diseases. Remote monitoring of patients with implantable devices and chronic diseases has resulted in better outcomes reducing health care costs and hospital admissions. New care models, which shift point of care to the outpatient setting and the patient's home, necessitate innovations in technology.
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Affiliation(s)
- Javier E Banchs
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology and Pacing, 2401 South 31st Street, Temple, TX 76508, USA.
| | - David Lee Scher
- Department of Medicine, Division of Cardiology, Penn State Hershey Heart & Vascular Institute, 500 University Drive, H047, Hershey, PA 17033, USA
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Pietrabissa G, Ceccarini M, Borrello M, Manzoni GM, Titon A, Nibbio F, Montano M, Bertone G, Gondoni L, Castelnuovo G. Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit. Front Psychol 2015; 6:298. [PMID: 25852614 PMCID: PMC4364083 DOI: 10.3389/fpsyg.2015.00298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so. OBJECTIVE The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy. CONCLUSION By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors. CLINICAL IMPLICATIONS MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Martina Ceccarini
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Maria Borrello
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Annamaria Titon
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Ferruccio Nibbio
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Mariella Montano
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianandrea Bertone
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Luca Gondoni
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
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Abstract
Permanent cardiac pacemakers (PPM) are effective in the treatment of bradycardia in a growing number of clinical scenarios. An appreciation of the capacity of PPMs to result in negative hemodynamic and proarrhythmic effects has grown alongside clinical experience with permanent pacing. Such experience has necessitated the development of algorithms aimed at optimizing device functionality across a broad spectrum of physiologic and pathologic conditions. This review highlights recent device-based algorithms used in automated threshold testing, reduction of right ventricular pacing, prevention and treatment of pacemaker-mediated tachycardia, mode switching for atrial tachyarrhythmias, rate-modulated pacing, and advances in arrhythmia storage and remote monitoring.
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Affiliation(s)
- Daniel Sohinki
- Division of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, USA.
| | - Owen A Obel
- Division of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, USA; Division of Cardiology, Veterans Health Administration (VA) North Texas Healthcare System, 4500 South Lancaster Road, Dallas, TX 75216, USA
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Affiliation(s)
- Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital (C.-P.L., C.-W.S., H.-F.T.) and Research Center of Heart, Brain, Hormone and Healthy Ageing, Li Ka Shing Faculty of Medicine (C.-W.S., H.-F.T.), University of Hong Kong, Hong Kong SAR, China
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