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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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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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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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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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Afzal A, Watson J, Choi JW, Schussler JM, Assar MD. Takotsubo cardiomyopathy in the setting of complete heart block. Proc (Bayl Univ Med Cent) 2018; 31:502-505. [PMID: 30948993 DOI: 10.1080/08998280.2018.1499314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022] Open
Abstract
Few cases of coincident takotsubo cardiomyopathy and complete heart block (CHB) have been reported. A 62-year-old woman presented with typical chest pain and was found to have CHB with a left ventricular ejection fraction of 35% and apical ballooning on ventriculogram. The patient was transvenously paced and a permanent biventricular pacemaker was placed when the CHB did not resolve. Repeat echocardiography 15 days after the event showed the ejection fraction to be 50%. This case highlights management strategies in this unique situation.
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Affiliation(s)
- Aasim Afzal
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas
| | - John Watson
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas
| | - James W Choi
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas.,Division of Cardiology, Texas A&M College of Medicine Health Science CenterDallasTexas
| | - Jeffrey M Schussler
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas.,Division of Cardiology, Texas A&M College of Medicine Health Science CenterDallasTexas
| | - Manish D Assar
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas.,Division of Cardiology, Texas A&M College of Medicine Health Science CenterDallasTexas
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Muresan L, Cismaru G, Martins RP, Bataglia A, Rosu R, Puiu M, Gusetu G, Mada RO, Muresan C, Ispas DR, Le Bouar R, Diene LL, Rugina E, Levy J, Klein C, Sellal JM, Poull IM, Laurent G, de Chillou C. Recommendations for the use of electrophysiological study: Update 2018. Hellenic J Cardiol 2018; 60:82-100. [PMID: 30278230 DOI: 10.1016/j.hjc.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
The field of cardiac electrophysiology has greatly developed during the past decades. Consequently, the use of electrophysiological studies (EPSs) in clinical practice has also significantly augmented, with a progressively increasing number of certified electrophysiology centers and specialists. Since Zipes et al published the Guidelines for Clinical Intracardiac Electrophysiology and Catheter Ablation Procedures in 1995, no official document summarizing current EPS indications has been published. The current paper focuses on summarizing all relevant data of the role of EPS in patients with different types of cardiac pathologies and provides up-to-date recommendations on this topic. For this purpose, the PubMed database was screened for relevant articles in English up to December 2018 and ESC and ACC/AHA Clinical Practice Guidelines, and EHRA/HRS/APHRS position statements related to the current topic were analyzed. Current recommendations for the use of EPS in clinical practice are discussed and presented in 17 distinct cardiac pathologies. A short rationale, evidence, and indications are provided for each cardiac disease/group of diseases. In conclusion, because of its capability to establish a diagnosis in patients with a variety of cardiac pathologies, the EPS remains a useful tool in the evaluation of patients with cardiac arrhythmias and conduction disorders and is capable of establishing indications for cardiac device implantation and guide catheter ablation procedures.
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Affiliation(s)
- Lucian Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France.
| | - Gabriel Cismaru
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Raphaël Pedro Martins
- Centre Hospitalier Universitaire de Rennes, Cardiology Department, 35000 Rennes, France
| | - Alberto Bataglia
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Radu Rosu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Mihai Puiu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Razvan Olimpiu Mada
- "Niculae Stancioiu" Heart Institute, Cardiology Department, 400005 Cluj-Napoca, Romania
| | - Crina Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Daniel Radu Ispas
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Ronan Le Bouar
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | | | - Elena Rugina
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Jacques Levy
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Cedric Klein
- Centre Hospitalier Universitaire de Lille, Cardiology Department, 59000 Lille, France
| | - Jean Marc Sellal
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Isabelle Magnin Poull
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Gabriel Laurent
- Centre Hospitalier Universitaire de Dijon, Cardiology Department, 21000 Dijon, France
| | - Christian de Chillou
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
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Abstract
The therapy of patients with syncope is oriented to the underlying pathophysiological mechanisms. Patients with reflex syncope require careful education regarding recognition of warning signs and the avoidance of trigger factors. Treatment with beta blockers is nowadays obsolete. Even other drugs have failed to show any benefit. Pacemaker therapy should only be considered if syncope attacks are frequent and if there is a correlation between symptoms and the electrocardiogram (ECG). Because autonomic failure in patients with orthostatic hypotension is often drug-induced, reduction of the dosage or the complete elimination is the treatment of choice in these patients. A higher than normal salt and fluid intake as well as general measures to avoid delayed venous backflow, e.g. elastic stockings, may also be helpful. A change in blood pressure medication can be decisive for therapy success, especially in elderly patients with arterial hypertension. Pacemaker and defibrillator therapy is the treatment of choice in patients with bradycardia and tachycardia arrhythmias, respectively. Although these measures are simple but effective, in individual cases it is still difficult to find clinical proof that arrhythmic disorders are the causal factors for the syncope. However, also in these patients cardiac pacing should be based on a symptom ECG correlation. The recently conducted market release of the injectable miniaturized ECG recorder will alleviate the diagnostic process. The limits of this approach, however, become obvious when there is the suspicion of a life-threatening rhythm disorder, because the only difference between syncope and sudden cardiac death is that in one case the patient wakes up again.
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Affiliation(s)
- D Andresen
- Klinik für Kardiologie, Intensivmedizin und Allgemeine Innere Medizin, Vivantes Klinikum Am Urban, Dieffenbachstr. 1, 10967, Berlin, Deutschland,
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Affiliation(s)
- Panos E Vardas
- Cardiology Department, Heraklion University Hospital, PO Box 1352, 71110 Heraklion, Greece.
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Abstract
Cardiovascular disease is the most common cause of death across the globe. Large disparities in access to cardiovascular care exist in the world. An estimated one million people die each year due to lack of access to life saving pacemaker therapy. We discuss the concept of justice in health and health care as it relates to the use of refurbished pacemakers in patients in low- and middle- income countries, where financial circumstances severely limit access to brand new devices. Egalitarianism, utilitarianism, and justice as fairness are examined, as they relate to provision of re-processed pacemakers. This practice, since it holds promise to improve human functioning and capabilities, can be morally justified with some conditions: transparency, further research in is its safety and efficacy, and its impact on other needs and priorities in those countries.
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 374] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 559] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Total beta-adrenoceptor knockout slows conduction and reduces inducible arrhythmias in the mouse heart. PLoS One 2012; 7:e49203. [PMID: 23133676 PMCID: PMC3486811 DOI: 10.1371/journal.pone.0049203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/05/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Beta-adrenoceptors (β-AR) play an important role in the neurohumoral regulation of cardiac function. Three β-AR subtypes (β(1), β(2), β(3)) have been described so far. Total deficiency of these adrenoceptors (TKO) results in cardiac hypotrophy and negative inotropy. TKO represents a unique mouse model mimicking total unselective medical β-blocker therapy in men. Electrophysiological characteristics of TKO have not yet been investigated in an animal model. METHODS In vivo electrophysiological studies using right heart catheterisation were performed in 10 TKO mice and 10 129SV wild type control mice (WT) at the age of 15 weeks. Standard surface ECG, intracardiac and electrophysiological parameters, and arrhythmia inducibility were analyzed. RESULTS The surface ECG of TKO mice revealed a reduced heart rate (359.2±20.9 bpm vs. 461.1±33.3 bpm; p<0.001), prolonged P wave (17.5±3.0 ms vs. 15.1±1.2 ms; p = 0.019) and PQ time (40.8±2.4 ms vs. 37.3±3.0 ms; p = 0.013) compared to WT. Intracardiac ECG showed a significantly prolonged infra-Hisian conductance (HV-interval: 12.9±1.4 ms vs. 6.8±1.0 ms; p<0.001). Functional testing showed prolonged atrial and ventricular refractory periods in TKO (40.5±15.5 ms vs. 21.3±5.8 ms; p = 0.004; and 41.0±9.7 ms vs. 28.3±6.6 ms; p = 0.004, respectively). In TKO both the probability of induction of atrial fibrillation (12% vs. 24%; p<0.001) and of ventricular tachycardias (0% vs. 26%; p<0.001) were significantly reduced. CONCLUSION TKO results in significant prolongations of cardiac conduction times and refractory periods. This was accompanied by a highly significant reduction of atrial and ventricular arrhythmias. Our finding confirms the importance of β-AR in arrhythmogenesis and the potential role of unspecific beta-receptor-blockade as therapeutic target.
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Crisel RK, Farzaneh-Far R, Na B, Whooley MA. First-degree atrioventricular block is associated with heart failure and death in persons with stable coronary artery disease: data from the Heart and Soul Study. Eur Heart J 2011; 32:1875-80. [PMID: 21606074 DOI: 10.1093/eurheartj/ehr139] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS First-degree atrioventricular block (AVB) has traditionally been considered a benign electrocardiographic finding in healthy individuals. However, the clinical significance of first-degree AVB has not been evaluated in patients with stable coronary heart disease. We investigated whether first-degree AVB is associated with heart failure (HF) and mortality in a prospective cohort study of outpatients with stable coronary artery disease (CAD). METHODS AND RESULTS We measured the P-R interval in 938 patients with stable CAD and classified them into those with (P-R interval ≥ 220 ms) and without (P-R interval <220 ms) first-degree AVB. Hazard ratios (HRs) and 95% confidence intervals were calculated for HF hospitalization and all-cause mortality. During 5 years of follow-up, there were 123 hospitalizations for HF and 285 deaths. Compared with patients who had normal atrioventricular conduction, those with first-degree AVB were at increased risk for HF hospitalization (age-adjusted HR 2.33: 95% CI 1.49-3.65; P= 0.0002), mortality [age-adjusted HR 1.58; 95% CI (1.13-2.20); P = 0.008], cardiovascular (CV) mortality [age-adjusted HR 2.33; 95% CI (1.28-4.22); P= 0.005], and the combined endpoint of HF hospitalization or CV mortality (age-adjusted HR 2.43: 95% CI 1.64-3.61; P ≤ 0.0001). These associations persisted after multivariable adjustment for heart rate, medication use, ischaemic burden, and QRS duration. Adjustment for left ventricular systolic and diastolic function partially attenuated the effect, but first-degree AVB remained associated with the combined endpoint of HF or CV death (HR 1.61, CI 1.02-2.54; P= 0.04). CONCLUSION In a large cohort of patients with stable coronary artery disease, first-degree AVB is associated with HF and death.
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Affiliation(s)
- Ryan K Crisel
- Department of Medicine, University of California, San Francisco, CA, USA
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary. Circulation 2008. [DOI: 10.1161/circualtionaha.108.189741] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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Epstein AE, Dimarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. Heart Rhythm 2008; 5:934-55. [PMID: 18534377 DOI: 10.1016/j.hrthm.2008.04.015] [Citation(s) in RCA: 267] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Indexed: 11/16/2022]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350-408. [PMID: 18483207 DOI: 10.1161/circualtionaha.108.189742] [Citation(s) in RCA: 935] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL, Gibbons RJ, Antman EM, Alpert JS, Gregoratos G, Hiratzka LF, Faxon DP, Jacobs AK, Fuster V, Smith SC. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation 2002; 106:2145-61. [PMID: 12379588 DOI: 10.1161/01.cir.0000035996.46455.09] [Citation(s) in RCA: 534] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Oter Rodríguez (coordinador) R, Juan Montiel JD, Roldán Pascual T, Bardají Ruiz A, Molinero de Miguel E. Guías de práctica clínica de la Sociedad Española de Cardiología en marcapasos. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75180-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Forty-eight patients with predominant aortic stenosis underwent His bundle electrography (HBE) at the time of diagnostic catheterization. Patients were divided into four groups based upon severity of calcification of the aortic valve fluoroscopically as judged independently by three angiographers. Of 48 patients, three had no calcification, 11 had mild, 18 had moderate, and 16 had severe aortic valve calcification. No correlation was found between HV interval and severity of aortic valve calcification. Significant correlation was found between HV interval prolongation and aortic valve area (p less than 0.02), history of congestive heart failure (p less than 0.02), and increasing left ventricular end-diastolic pressure (p less than 0.05). Left ventricular ejection fraction less than 45% had greater likelihood of HV interval prolongation (p less than 0.01). No correlation was established between HV interval and age, aortic valve gradient, left ventricular peak systolic pressure, syncope, and coronary artery disease. Aortic valve area was the most significant independent predictor of HV prolongation, with history of congestive heart failure second. We conclude that HV interval prolongation in aortic stenosis with calcified valves is best predicted by evidence of declining left ventricular function rather than severity of aortic valve calcification.
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Erikssen J, Otterstad JE. Natural course of a prolonged PR interval and the relation between PR and incidence of coronary heart disease. A 7-year follow-up study of 1832 apparently healthy men aged 40-59 years. Clin Cardiol 1984; 7:6-13. [PMID: 6705291 DOI: 10.1002/clc.4960070104] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
During a baseline cardiovascular survey PR was measured in a strictly standardized way in 1832 men aged 40-59 years, free from coronary heart disease (CHD). Of 1758 men still alive, 1585 underwent an identical follow-up study 7 years later. A total of 1570 were in sinus rhythm. The following findings were made: (1) Baseline and follow-up prevalence of a prolonged PR (greater than or equal to 0.22 s) was identical (5.3 vs. 5.4%). (2) Only 60% of restudied men with a prolonged PR also had prolonged PR at follow-up. (3) Only 1 of 98 with a prolonged baseline PR had a more advanced AV block at follow-up, whereas an additional 4 had conditions which might influence the AV node (1 Bechterew's disease and 3 mild aortic valve stenosis). (4) The incidence of all CHD events found during the follow-up study (CHD deaths, myocardial infarction, angina pectoris, and pathologic exercise ECGs) was moderately but significantly lower in men with a prolonged PR than among men with a PR less than or equal to 0.21 s. Thus a prolonged PR is rarely an indicator of impending, more severe conduction disturbances; it is mostly a benign, functional finding in middle-aged men free from overt heart disease and is not positively associated with CHD. Rather PR may be moderately and inversely associated with latent CHD.
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Ginks W, Sutton R, Siddons H, Leatham A. Unsuspected coronary artery disease as cause of chronic atrioventricular block in middle age. Heart 1980; 44:699-702. [PMID: 6970044 PMCID: PMC482468 DOI: 10.1136/hrt.44.6.699] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Attention has recently been drawn to the relatively poor prognosis of middle aged patients paced for chronic atrioventricular block when age-linked expectation of life is taken into account, and it has been suggested that this may be the result of underlying coronary artery disease, despite the absence of symptoms to suggest this. It was the purpose of this study to determine the incidence of unsuspected coronary artery disease in middle aged patients presenting with chronic atrioventricular block. Studies were made on a consecutive series of 30 patients aged 45 to 65 (mean age 56 years) with chronic atrioventricular disease who had been referred for pacing. Patients presenting with acute myocardial infarction or angina or with sinuatrial disease without atrioventricular disease were excluded. Coronary arteriography disclosed the presence of severe coronary artery disease in 13 patients. Of the remaining 17 patients, four had congestive cardiomyopathy, two had hypertrophic cardiomyopathy, one had aortic stenosis, and in 10 patients the aetiology of the heart block was unknown. Myocardial revascularisation was undertaken in six patients with paroxysmal atrioventricular block caused by coronary artery disease. Operation did not result in any sustained improvement in atrioventricular conduction.
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Cohen SI, Smith LK, Aoresty JM, Voukydis P, Morkin E. Atrioventricular conduction in patients with clinical indications for transvenous cardiac pacing. Heart 1975; 37:583-92. [PMID: 1148056 PMCID: PMC482840 DOI: 10.1136/hrt.37.6.583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Eighty patients with clinical indications for cardiac pacing had atrioventricular conduction analysed by His bundle study. The indications for cardiac pacing included high grade atrioventricular block, sick sinus node syndrome without tachycardia, bradycardia-tachycardia syndrome, unstable bilateral bundle-branch block, and uncontrolled ventricular irritability. Complete heart block, Wenckeback block (Mobitz I), and 2:1 block were noted proximal and distal to the His bundle. Mobitz II block only occurred distal to the His bundle. Of special interest were the high incidence of distal conduction abnormalities by His bundle analysis (40/80, 50%), the re-establishment of normal atrioventricular conduction in acutely ill patients with recent evidence of heart block, and the high incidence of intraventricular conduction disturbances on standard electrocardiogram (48/80, 60%).
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Abstract
A simple classification of atrioventricular block, criteria for diagnosis, and suggested therapy are discussed. The differences between Mobitz I and II second-degree A-V block are reviewed.
Good management of patients who have bundle-branch or other forms of intraventricular block depends on informed judgment which includes consideration of (1) the effect of intraventricular conduction disturbances on the pumping action of the heart, and (2) the likelihood that a specific intraventricular conduction disturbance will be complicated by complete heart block.
Evidence suggests that common forms of intraventricular disturbance, unlike ventricular fibrillation, do not alter significantly the pumping action of the heart. The role of intraventricular conduction disturbances in the genesis of ventricular fibrillation is assessed.
We concluded that only when right bundle-branch block is combined with block of the anterior or posterior fascicle of the left bundle branch is complete heart block sufficiently imminent to warrant special concern. If bilateral block is associated with symptoms of episodic severe bradycardia, pacemaker therapy is indicated.
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Abstract
Some, but not all, cardiac arrhythmias are related to pathologic lesions of the cardiac conduction system. Common atrial dysrhythmias and first-degree atrioventricular (A-V) block rarely are explained on the basis of anatomic lesions in specific sites of the conduction system or its blood supply. Second-degree A-V block of Mobitz type II, which may be a precursor of complete (third-degree) heart block, commonly is associated with fibrotic lesions of uncertain etiology in the branching part of the bundle of His or the bundle branches. Ischemic lesions are found less often, and other pathologic processes rarely are present. Chronic complete heart block most often results from nonspecific, fibrotic interruption of the distal bundle of His, or of the first parts of the bundle branches after their origins. Ischemic lesions are uncommonly the cause of chronic block. High-grade A-V block complicating acute myocardial infarction may be associated with infarction of the A-V conduction system, but often morphologic evidence of ischemia cannot be identified. Congenital variants in anatomy of the conduction system are responsible for some relatively uncommon arrhythmias.
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Schaudig A, Meisner H, Thurmayr R, Lucas M, Zimmermann M. [Results, function times and monitoring following pacemaker therapy]. LANGENBECKS ARCHIV FUR CHIRURGIE 1971; 329:608-21. [PMID: 5161703 DOI: 10.1007/bf01770605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kahn DR, Kirsh MM, Vathayanon S, Willis PW, Walton JA, McIntosh K, Ferguson PW, Sloan H. Long-term evaluation of the General Electric cardiac pacemaker. Thorax 1970; 25:267-9. [PMID: 5452278 PMCID: PMC472694 DOI: 10.1136/thx.25.3.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A review of General Electric (G.E.) electronic cardiac pacemakers for symptomatic complete A-V heart block in two sequential three-year periods at the University of Michigan Medical Center indicates that there has been no increase in the useful life of these units. With G.E. epicardial pacemakers failure occurred after an average of 12 months. In the early years the major cause of failure was wire breakage, and the later major cause was battery exhaustion or component failure. Exit block was a major complication. There was no improvement when G.E. catheter pacemakers were used instead of the epicardial type. The Medtronic catheter pacemakers lasted longer, with fewer battery and component failures and no instances of exit block. Although infection was more common with Medtronic pacemakers, secondary to erosion of the power unit or the catheter through the skin, it may be that this complication could be eliminated by locating the battery box beneath the latissimus dorsi muscle in the axilla and by careful catheter placement to avoid pressure necrosis and subsequent cutaneous perforation.
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Goldstein S, Moss AJ, Rivers RJ, Weiner RS. Transthoracic and transvenous pacemakers. A comparative clinical experience with 131 implantable units. Heart 1970; 32:35-45. [PMID: 5417845 PMCID: PMC487270 DOI: 10.1136/hrt.32.1.35] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Dack S, Donoso E. Heart block with Stokes-Adams syndrome: indications and results of cardiac pacing. Ann N Y Acad Sci 1969; 167:519-33. [PMID: 5263798 DOI: 10.1111/j.1749-6632.1969.tb34112.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Norris RM. Heart block in posterior and anterior myocardial infarction. BRITISH HEART JOURNAL 1969; 31:352-6. [PMID: 5401814 PMCID: PMC487504 DOI: 10.1136/hrt.31.3.352] [Citation(s) in RCA: 109] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Harris A, Davies M, Redwood D, Leatham A, Siddons H. Aetiology of chronic heart block. A clinico-pathological correlation in 65 cases. Heart 1969; 31:206-18. [PMID: 5775291 PMCID: PMC487482 DOI: 10.1136/hrt.31.2.206] [Citation(s) in RCA: 92] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Begg FR, Magovern GJ, Cushing WJ, Kent EM, Fisher DL. Selective cine coronary arteriography in patients with complete heart block. J Thorac Cardiovasc Surg 1969. [DOI: 10.1016/s0022-5223(19)42758-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cartmill TB, Clarke FB, Nicks R, Bernstein L. Treatment of complete heart block using an implantable transvenous pacemaker of Australian manufacture: technique and results. Med J Aust 1968; 2:260-2. [PMID: 5672946 DOI: 10.5694/j.1326-5377.1968.tb29417.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Lassers BW, Julian DG. Artificial pacing in management of complete heart block complicating acute myocaerdial infarction. BRITISH MEDICAL JOURNAL 1968; 2:142-6. [PMID: 5641975 PMCID: PMC1989199 DOI: 10.1136/bmj.2.5598.142] [Citation(s) in RCA: 84] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Harris A, Redwood D, Davies M, Davies G. Causes of death in patients with complete heart block and aritificial pacemakers. Heart 1968; 30:14-9. [PMID: 5637550 PMCID: PMC459201 DOI: 10.1136/hrt.30.1.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Morris JJ, Whalen RE, McIntosh HD, Thompson HK, Brown IW, Young WG. Permanent ventricular pacemakers. Comparison of transthoracic and transvenous implantation. Circulation 1967; 36:587-97. [PMID: 6041871 DOI: 10.1161/01.cir.36.4.587] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In the series of 86 patients with the Stokes-Adams syndrome or with symptomatic bradycardia managed with permanently implanted ventricular pacemakers reported on, 35 patients had primary implantation of epicardial leads at thoracotomy and 51 had transvenous endocardial electrodes passed via the jugular venous system for permanent ventricular pacing. The transvenous method of permanent pacemaker implantation appears to be easier to apply with less serious complications and provides the same overall mortality as the transthoracic approach. However, pacemaker failure, both permanent and temporary, is more likely to occur with the transvenous approach.
A series of unique complications and findings noted in the transvenous group were thought to be related to the permanent pacing electrode catheter. These included myothought cardial perforation, pericardial friction rubs, intermittent ventricular pacing, and diaphragmatic stimulation.
The experience suggests that it is reasonable to employ a transvenous pacemaker initially, recognizing that replacement with a transthoracic pacemaker will be necessary in approximately 16% of the patients and remanipulation of the electrode catheter will be needed in another 13%. Therefore, to undertake transvenous permanent implantation of a pacemaker, one must also be prepared to employ the transthoracic approach in a small but significant number of patients.
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