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Vora AN, Freeman JV, Enriquez AD. Cutting the Cord: Time for Leadless Pacemakers to Untether Post-TAVR Patients? JACC Cardiovasc Interv 2024:S1936-8798(24)00907-5. [PMID: 39023451 DOI: 10.1016/j.jcin.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Amit N Vora
- Yale University School of Medicine, New Haven, Connecticut, USA.
| | - James V Freeman
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alan D Enriquez
- Yale University School of Medicine, New Haven, Connecticut, USA
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2
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Wright DJ, Trucco ME, Zhou J, Wolff C, Holbrook R, Margetta J, El-Chami MF. Chronic kidney disease and transvenous cardiac implantable electronic device infection-is there an impact on healthcare utilization, costs, disease progression, and mortality? Europace 2024; 26:euae169. [PMID: 38890126 PMCID: PMC11223657 DOI: 10.1093/europace/euae169] [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: 03/28/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
AIMS Cardiac implantable electronic device (CIED) infections are a burden to hospitals and costly for healthcare systems. Chronic kidney disease (CKD) increases the risk of CIED infections, but its differential impact on healthcare utilization, costs, and outcomes is not known. METHODS AND RESULTS This retrospective analysis used de-identified Medicare Fee-for-Service claims to identify patients implanted with a CIED from July 2016 to December 2020. Outcomes were defined as hospital days and costs within 12 months post-implant, post-infection CKD progression, and mortality. Generalized linear models were used to calculate results by CKD and infection status while controlling for other comorbidities, with differences between cohorts representing the incremental effect associated with CKD. A total of 584 543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. The average total days in hospital for infected patients was 23.5 days with CKD vs. 14.5 days (P < 0.001) without. The average cost of infection was $121 756 with CKD vs. $55 366 without (P < 0.001), leading to an incremental cost associated with CKD of $66 390. Infected patients with CKD were more likely to have septicaemia or severe sepsis than those without CKD (11.0 vs. 4.6%, P < 0.001). After infection, CKD patients were more likely to experience CKD progression (hazard ratio 1.26, P < 0.001) and mortality (hazard ratio 1.89, P < 0.001). CONCLUSION Cardiac implantable electronic device infection in patients with CKD was associated with more healthcare utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.
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Affiliation(s)
- David J Wright
- Cardiology Division, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - María Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta and Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Jiani Zhou
- Cardiac Rhythm Management, Medtronic plc, 8200 Coral Sea Street, MVC71 Mounds View, MN 55112, USA
| | - Claudia Wolff
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Reece Holbrook
- Cardiac Rhythm Management, Medtronic plc, 8200 Coral Sea Street, MVC71 Mounds View, MN 55112, USA
| | - Jamie Margetta
- Cardiac Rhythm Management, Medtronic plc, 8200 Coral Sea Street, MVC71 Mounds View, MN 55112, USA
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology, Emory University Hospital, Atlanta, GA, USA
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3
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Ip JE. The complex decision of leadless cardiac pacing: How to choose among the expanding options? Heart Rhythm 2024:S1547-5271(24)02825-X. [PMID: 38944319 DOI: 10.1016/j.hrthm.2024.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Affiliation(s)
- James E Ip
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 10065.
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4
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Ishibashi K, Kusano K. New Approach Concept of Leadless Pacemaker Implantation for Smaller Hearts. Circ J 2024; 88:1135-1137. [PMID: 38839377 DOI: 10.1253/circj.cj-24-0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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5
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Braghieri L, Ahmed A, Curtis AB, Kim JA, Connolly AT, Nabutovsky Y, Kim G, Ganz L, Wilkoff BL. Evaluating Cardiac Lead Safety Using Observational, Real-World Data: EP PASSION Proof-of-Concept Study. Heart Rhythm 2024:S1547-5271(24)02819-4. [PMID: 38936445 DOI: 10.1016/j.hrthm.2024.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Traditional post-approval study (PAS) designs have been accepted by regulatory authorities to fulfill post-marketing requirements for cardiac leads but they have several limitations. OBJECTIVES The authors conducted a proof-of-concept study of alternative methods that utilize real-world data (RWD) to evaluate lead safety in large patient populations. METHODS Abbott patient device databases were linked with Medicare Fee-For-Service (FFS) claims to identify lead complications among patients implanted with Abbott Optisure™ lead. A 1:1 comparison between the PAS method and RWD method of detecting mechanical lead-related complication events was conducted in 444 PAS subjects who were enrolled in Medicare FFS. Agreement between methods was evaluated using McNemar's test and Cohen's kappa. Survival free from complications at 3 years was compared between the PAS and RWD cohorts using an equivalence acceptance criterion of ±2.5%. RESULTS There were 1,171 PAS patients and 5,804 Medicare FFS patients who received an Optisure™ lead between August 27, 2014 - June 14, 2016. Patients were followed through December 31, 2018. Complete agreement was found between PAS-reported and claims-detected complications (McNemar's p-value=1.00, Cohen's Kappa = 1.0). Survival free from complications at 3 years using the RWD method was 98.4% (95% CL: 98.0%-98.7%), which was within the acceptable range of the PAS 98.4% (95% CL: 97.6%-99.0%). CONCLUSION These results show a close agreement between RWD-detected and PAS-reported lead complication rates, which highlight the potential benefits of RWD-based methods to enhance the generation of clinical evidence for lead safety.
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Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aamir Ahmed
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA;.
| | - Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | | | | | - Grant Kim
- Abbott Laboratories, Sylmar, CA, USA
| | | | - Bruce L Wilkoff
- Cleveland Clinic Heart, Thoracic, and Vascular Institute, Cleveland, OH, USA
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6
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Oliveira VMR, Rivera A, Oliveira IC, de Sousa AM, Nishikubo MEP, Serpa F, da Silva Menezes Junior A. The Effectiveness and Safety of Leadless Pacemakers: An Updated Meta-Analysis. Curr Cardiol Rep 2024:10.1007/s11886-024-02079-6. [PMID: 38869811 DOI: 10.1007/s11886-024-02079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Leadless pacemakers (LPs) are promising alternatives to traditional transvenous pacemakers (TVPs), but their comparative effectiveness and safety in clinical outcomes remain uncertain. METHODS We systematically searched PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov for studies comparing LPs and TVPs. A restricted maximum likelihood random-effects model was used for all outcomes. Heterogeneity was assessed using I2 statistics. We performed a subgroup analysis with studies with multivariate-adjusted data. RESULTS We included 21 studies involving 47,229 patients, of whom 12,199 (25.8%) underwent LP implantation. Compared with TVPs, LPs were associated with a significantly lower risk of overall complications (OR 0.61; 95% CI 0.45-0.81; p < 0.01), dislodgement (OR 0.34; 95% CI 0.20-0.56; p < 0.01), and pneumothorax (OR 0.27; 95% CI 0.16-0.46; p < 0.01). No significant difference in all-cause mortality was observed in the overall analysis (OR 1.43; 95% CI 0.65-3.15; p = 0.35) and in studies with multivariate-adjusted data (OR 1.34; 95% CI 0.65-2.78; p = 0.43). However, LPs were associated with a higher risk of pericardial effusion (OR 2.47; 95% CI 1.39-4.38; p < 0.01) and cardiac tamponade (OR 3.75; 95% CI 2.41-5.83; p < 0.01). LPs also demonstrated a lower pacing capture threshold (MD -0.19 V; 95% CI [-0.23 V]-[-0.16 V]; p < 0.01), but no significant difference in impedance (MD 32.63 ohms; 95% CI [-22.50 ohms]-[87.76 ohms]; p = 0.25). CONCLUSIONS These findings suggest that LPs were associated with lower overall complication rates and similar effectiveness to TVPs. However, randomized controlled trials are warranted to validate these results.
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Affiliation(s)
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo Do Campo, Brazil
| | | | | | | | - Frans Serpa
- Division of Cardiology, Beth Israel Deaconess Center, Harvard Medical School, Boston, USA
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7
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Kuschyk J, Sattler K, Fastenrath F, Rudic B, Akin I. [Treatment with cardiac electronic implantable devices]. Herz 2024; 49:233-246. [PMID: 38709278 DOI: 10.1007/s00059-024-05246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
Cardiac device therapy provides not only treatment options for bradyarrhythmia but also advanced treatment for heart failure and preventive measures against sudden cardiac death. In heart failure treatment it enables synergistic reverse remodelling and reduces pharmacological side effects. Cardiac resynchronization therapy (CRT) has revolutionized the treatment of reduced left ventricular ejection fraction (LVEF) and left bundle branch block by decreasing the mortality and morbidity with improvement of the quality of life and resilience. Conduction system pacing (CSP) as an alternative method of physiological stimulation can improve heart function and reduce the risk of pacemaker-induced cardiomyopathy. Leadless pacers and subcutaneous/extravascular defibrillators offer less invasive options with lower complication rates. The prevention of infections through preoperative and postoperative strategies enhances the safety of these therapies.
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Affiliation(s)
- Jürgen Kuschyk
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Katherine Sattler
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Fabian Fastenrath
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Boris Rudic
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
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8
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Huang J, Bhatia NK, Lloyd MS, Westerman S, Shah A, Delurgio D, Patel AM, Tompkins C, El-Chami MF, Merchant FM. Impact of omitting the intravenous heparin bolus on outcomes of leadless pacemaker implantation. J Cardiovasc Electrophysiol 2024; 35:1212-1216. [PMID: 38650520 DOI: 10.1111/jce.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Early guidance recommended a bolus of intravenous heparin at the beginning of leadless pacemaker (LP) implantation procedures. However, due to concern about bleeding complications, more recent practice has tended toward omitting the bolus and only running a continuous heparin infusion through the introducer sheath. The impact of omitting the heparin bolus on procedural outcomes is not clear. METHODS We reviewed all Medtronic Micra LP implants at our institution from 9/2014 to 9/2022. The decision to bolus with heparin was at operator discretion. RESULTS Among 621 LP implants, 326 received an intravenous heparin bolus, 243 did not, and 52 patients were excluded because heparin bolus status could not be confirmed. There was a trend toward more frequent omission of the heparin bolus with more recent implants. Median follow-up after LP implant was 14.3 (interquartile range [IQR]: 8.4-27.9) months. There was no difference between heparin bolus and no bolus groups in the number of device deployments/recaptures (1.42 ± 0.81 vs. 1.31 ± 0.66, p = .15). Implant-related adverse events were also similar between heparin bolus and no bolus groups: access-site hematoma requiring intervention (7 vs. 5, p = .99), pseudoaneurysm (1 vs. 1, p = .99), cardiac perforation (1 vs. 1, p = .99), intraprocedural device thrombus formation (2 vs. 4, p = .41), 30-day rehospitalization (21 vs. 15, p = .98), and 30-day all-cause mortality (16 vs. 14, p = .70). There was one additional nonfatal cardiac perforation in a patient who was excluded due to unknown heparin bolus status. Regarding device electrical parameters between heparin bolus and no bolus groups, there were no significant differences at the time of implant: pacing capture threshold 0.5 ± 0.4 vs. 0.5 ± 0.3, p = .10; pacing impedance 739.9 ± 226.4 vs. 719.1 ± 215.4, p = .52; R wave sensing 11.7 ± 5.7 vs. 12.0 ± 5.4, p = .34). Long-term device performance was also similar between groups. CONCLUSION Omission of the systemic heparin bolus at the time of LP implantation appears safe in appropriately selected patients. Heparin bolus may still be considered in long cases requiring multiple device deployments or in patients at high risk for thrombotic complications.
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Affiliation(s)
- Jingwen Huang
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal K Bhatia
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy Westerman
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Delurgio
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anshul M Patel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine Tompkins
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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9
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Al-Khatib SM. Toward safer catheter-based electrophysiology procedures: First do no net harm! Heart Rhythm 2024:S1547-5271(24)02396-8. [PMID: 38762135 DOI: 10.1016/j.hrthm.2024.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Sana M Al-Khatib
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
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10
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Vardas PE. Leadless and scarless pacing: towards symbiotic nanogenerators. Eur Heart J 2024; 45:1252-1254. [PMID: 38442144 DOI: 10.1093/eurheartj/ehae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Panos E Vardas
- Medical School, University of Crete, Heraklion, Greece
- Biomedical Research Foundation Academy of Athens, Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, Athens 15123, Greece
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11
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El-Chami MF, Garweg C, Clementy N, Al-Samadi F, Iacopino S, Martinez-Sande JL, Roberts PR, Tondo C, Johansen JB, Vinolas-Prat X, Cha YM, Grubman E, Bordachar P, Stromberg K, Fagan DH, Piccini JP. Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry. Eur Heart J 2024; 45:1241-1251. [PMID: 38426911 PMCID: PMC10998730 DOI: 10.1093/eurheartj/ehae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Prior reports have demonstrated a favourable safety and efficacy profile of the Micra leadless pacemaker over mid-term follow-up; however, long-term outcomes in real-world clinical practice remain unknown. Updated performance of the Micra VR leadless pacemaker through five years from the worldwide post-approval registry (PAR) was assessed. METHODS All Micra PAR patients undergoing implant attempts were included. Endpoints included system- or procedure-related major complications and system revision rate for any cause through 60 months post-implant. Rates were compared through 36 months post-implant to a reference dataset of 2667 transvenous pacemaker patients using Fine-Gray competing risk models. RESULTS 1809 patients were enrolled between July 2015 and March 2018 and underwent implant attempts from 179 centres in 23 countries with a median follow-up period of 51.1 months (IQR: 21.6-64.2). The major complication rate at 60 months was 4.5% [95% confidence interval (CI): 3.6%-5.5%] and was 4.1% at 36 months, which was significantly lower than the 8.5% rate observed for transvenous systems (HR: .47, 95% CI: .36-.61; P < .001). The all-cause system revision rate at 60 months was 4.9% (95% CI: 3.9%-6.1%). System revisions among Micra patients were mostly for device upgrades (41.2%) or elevated thresholds (30.6%). There were no Micra removals due to infection noted over the duration of follow-up. At 36 months, the system revision rate was significantly lower with Micra vs. transvenous systems (3.2% vs. 6.6%, P < .001). CONCLUSIONS Long-term outcomes with the Micra leadless pacemaker continue to demonstrate low rates of major complications and system revisions and an extremely low incidence of infection.
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Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Christophe Garweg
- Department of Cardiovascular Sciences, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Regional Universitaire de Tours—Hopital Trousseau, Tours, France
| | - Faisal Al-Samadi
- Department of Medicine, King Salman Heart Center—King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saverio Iacopino
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Jose Luis Martinez-Sande
- Arrhythmia Unit, Cardiology Service, University Clinical Hospital of Santiago de Compostela, CIBER-CV, IDIS, Santiago de Compostela, Spain
| | - Paul R Roberts
- Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Claudio Tondo
- Monzino Cardiac Center, IRCCS, Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | | | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Grubman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital, Pessac-Bordeaux, France
| | | | | | - Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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12
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Da Costa A, Benali K. Leadless pacemaker: The revolution is underway. Trends Cardiovasc Med 2024:S1050-1738(24)00029-X. [PMID: 38555030 DOI: 10.1016/j.tcm.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Antoine Da Costa
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France.
| | - Karim Benali
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France
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13
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Beccarino N, Saleh M, Epstein LM. Leadless pacemakers: Where are we? Trends Cardiovasc Med 2024:S1050-1738(24)00018-5. [PMID: 38522582 DOI: 10.1016/j.tcm.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/10/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
Pacemakers have been the cornerstone of brady-arrhythmia management since the mid-20th century. Despite the widespread use and success of traditional transvenous pacemakers, they are associated with an estimated 15 % complication rate at three years. Driven by the advantages over traditional transvenous pacemakers including a lack of transvenous leads, resistance to infection, and ease of implantation, the number of leadless pacemakers placed annually in the United States has dramatically increased since their initial approval. While current iterations of leadless pacemakers lack the versatility offered by transvenous devices, recent advances in leadless pacing offer an increasingly diverse range of therapeutic options. This review will discuss the past, present, and future emerging technologies, and strategies in leadless pacing.
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Affiliation(s)
- Nicholas Beccarino
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States.
| | - Moussa Saleh
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States
| | - Laurence M Epstein
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States
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14
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Al-Khatib SM. Cardiac Implantable Electronic Devices. N Engl J Med 2024; 390:442-454. [PMID: 38294976 DOI: 10.1056/nejmra2308353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Sana M Al-Khatib
- From the Division of Cardiology and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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15
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Habboush S, Elmoursi A, Gadelmawla AF, Masoud AT, Khalil M, Sheashaa H, Merza N, Massoud AT. Transvenous Compared With Leadless Pacemakers: A meta-analysis comparing TP versus LP. Cardiol Rev 2024:00045415-990000000-00202. [PMID: 38299806 DOI: 10.1097/crd.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
This study aims to compare the effectiveness of leadless pacemakers (LPs) and transvenous pacemakers and to examine the safety of both methods. We included patients undergoing single-chamber pacemaker implantation, either LP or TVP. Our outcomes were successful implantation rate, major complication, vascular injury, tamponade, and pneumothorax. We performed a double-arm analysis comparing LP versus TVP, with risk ratio (RR) and 95% confidence interval. A total of 10 studies were included in this meta-analysis. Regarding efficacy endpoints, RR revealed no significant difference between the LP and transvenous pacemaker groups in terms of successful rate of implantation (RR = 1.00; P = 0.77). Regarding safety outcomes, LP experienced lower incidence of major complications (RR = 0.47; P = 0.01), infection (RR = 0.24; P = 0.001), and tamponade (RR = 0.36; P = 0.01). There was no significant difference between both groups regarding pneumothorax (RR = 0.35; P = 0.22) and vascular injury (RR = 1.55; P = 0.25). The study findings suggest that both LPs and TVPs have similar effectiveness. Moreover, the incidences of pneumothorax, vascular injuries, and major complications were found to be comparable between the 2 methods. However, LPs were found to have lower rates of infection and tamponade.
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Affiliation(s)
- Shady Habboush
- From the Department of cardiology, Marien Hospital Witten, Witten, Germany
| | - Ahmed Elmoursi
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ahmed F Gadelmawla
- Department of Cardiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amr T Masoud
- Department of Medical Research, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed Khalil
- Department of Cardiology, Faculty of Medicine, Cairo University, Menoufia, Egypt
| | - Hesham Sheashaa
- Internal Medicine Department, University of Toledo, Toledo, OH
| | - Nooraldin Merza
- Internal Medicine Department, University of Toledo, Toledo, OH
| | - Ahmed T Massoud
- Department of Medical Research, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Troisi F, Caccavo VP, Santobuono VE, Sgarra L, Carella MC, Basile P, Guaricci AI, Grimaldi M. Left atrial strain is a good predictor of atrio-ventricular synchrony in leadless pacemaker pacing. J Cardiovasc Electrophysiol 2024; 35:155-161. [PMID: 38010993 DOI: 10.1111/jce.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION The importance of atrio-ventricular synchrony pacing in sinus rhythm patients is known. To identify patients in whom leadless pacemakers are able to guarantee this atrio-ventricular synchrony, we explored correlations among echocardiographic measures of left atrial (LA) size and function (doppler parameter and strain) with A4 amplitude in patients implanted with new generation Micra-AV device. METHODS After implantation with Micra-AV system, patients underwent device interrogation to evaluate AV synchrony based on the sensing of atrial mechanics and echocardiographic exam to assess LA morphology and LA function. RESULTS In the 21 studied patients (14 males, 72 ± 13 years), the A4 wave amplitude values inversely correlated with LA antero-posterior diameter, LA volume, LA contraction strain and LA conduit strain, while they were positively related with LA reservoir strain. DISCUSSION Our results indicate a statistically significant relationship between morphological echocardiographic LA parameters and atrial contraction signal (A4), detected by leadless pacemakers and used to synchronize ventricular pacing with the atrium. Instantaneous LA function assessment obtained with LA strain provides incremental information over morphological parameters. LA strain evaluates atrial myocardial deformation during the whole cardiac cycle. We found higher value of A4 in patients that have grater absolute value of LAsr, LAscd and LAsct, that are simple and measurable parameters of LA functional capacity. CONCLUSION Preimplant echocardiographic evaluation of the atrial contractility may be useful in predicting adequate A4 sensing and consequently a good atrio-ventricular synchrony pacing. Echocardiography LA strain study seems promising in Micra-AV patient selection.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital "F. Miulli", Bari, Italy
| | - Vincenzo P Caccavo
- Cardiology Department, Regional General Hospital "F. Miulli", Bari, Italy
| | - Vincenzo E Santobuono
- Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Luca Sgarra
- Cardiology Department, Regional General Hospital "F. Miulli", Bari, Italy
| | - Maria C Carella
- Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Basile
- Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea I Guaricci
- Interdisciplinary Department of Medicine, Cardiology Unit Polyclinic of Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital "F. Miulli", Bari, Italy
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Huang J, Bhatia NK, Lloyd MS, Westerman S, Shah A, Leal M, Delurgio D, Patel AM, Tompkins C, Leon AR, El-Chami MF, Merchant FM. Gender Differences With Leadless Pacemakers: Periprocedural Complications, Long-Term Device Function, and Clinical Outcomes. Am J Cardiol 2024; 210:229-231. [PMID: 37890565 DOI: 10.1016/j.amjcard.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Neal K Bhatia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy Westerman
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anand Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Miguel Leal
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David Delurgio
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anshul M Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Christine Tompkins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Huang J, Bhatia NK, Lloyd MS, Westerman S, Shah A, Leal M, Delurgio D, Patel AM, Tompkins C, Leon AR, El-Chami MF, Merchant FM. Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions. J Cardiovasc Electrophysiol 2023; 34:2216-2222. [PMID: 37727925 DOI: 10.1111/jce.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Permanent pacing indications are common after cardiac surgery and transcatheter structural valve interventions. Leadless pacemakers (LPs) have emerged as a useful alternative to transvenous pacemakers. However, current commercially available LPs are unable to provide atrial pacing or cardiac resynchronization and relatively little is known about LP outcomes after cardiac surgery and transcatheter valve interventions. METHODS This retrospective study included patients who received a Micra VR (MicraTM MC1VR01) or Micra AV (MicraTM MC1AVR1) (Medtronic) leadless pacemaker following cardiac surgery or transcatheter structural valve intervention between September 2014 and September 2022. Device performance and clinical outcomes, including ventricular pacing burden, ejection fraction, and need for conversion to transvenous pacing systems, were evaluated during follow-up. RESULTS A total of 78 patients were included, of whom 40 received a Micra VR LP implant, and 38 received a Micra AV LP implant. The mean age of the cohort was 65.9 ± 17.9 years, and 48.1% were females. The follow-up duration for the entire cohort was 1.3 ± 1.1 years: 1.6 ± 1.3 years for the Micra VR group and 0.8 ± 0.5 years for the Micra AV group. Among the cohort, 50 patients had undergone cardiac surgery and 28 underwent transcatheter structural valve interventions. Device electrical performance was excellent during follow-up, with a small but clinically insignificant increase in ventricular pacing threshold and a slight decrease in pacing impedance. The mean right ventricle pacing (RVP) burden significantly decreased over time in the entire cohort (74.3% ± 37.2% postprocedure vs. 47.7% ± 40.6% at last follow-up, p < .001), and left ventricle ejection fraction (LVEF) showed a modest but significant downward trend during follow-up (55.0% ± 10.6% vs. 51.5% ± 11.2% p < .001). Patients with Micra VR implants had significantly reduced LVEF during follow-up (54.1% ± 11.9% vs. 48.8% ± 11.9%, p = .003), whereas LVEF appeared stable in the Micra AV group during follow-up (56.1% ± 9.0% vs. 54.6% ± 9.7%, p = .06). Six patients (7.7%) required conversion to transvenous pacing systems, four who required cardiac resynchronization for drop in LVEF with high RVP burden and two who required dual-chamber pacemakers for symptomatic sinus node dysfunction. CONCLUSION Leadless pacemakers provide a useful alternative to transvenous pacemakers in appropriately selected patients after cardiac surgery and transcatheter structural valve interventions. Device performance is excellent over medium-term follow-up. However, a significant minority of patients require conversion to transvenous pacing systems for cardiac resynchronization or atrial pacing support, demonstrating the need for close electrophysiologic follow-up in this cohort.
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Affiliation(s)
- Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal K Bhatia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Stacy Westerman
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Anand Shah
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Miguel Leal
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - David Delurgio
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Anshul M Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Christine Tompkins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Angel R Leon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Division of Cardiology, Atlanta, Georgia, USA
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Briongos-Figuero S, Estévez Paniagua Á, Sánchez Hernández A, Jiménez Loeches S, Gómez Mariscal E, Vaqueriza Cubillo D, Muñoz-Aguilera R. Atrial mechanical contraction and ambulatory atrioventricular synchrony: Predictors from the OPTIVALL study. J Cardiovasc Electrophysiol 2023; 34:1904-1913. [PMID: 37482952 DOI: 10.1111/jce.16016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION The role that preprocedural factors have on atrioventricular synchrony (AVS) provided by leadless pacemakers requires investigation. METHODS AND RESULTS We aimed to assess the correlation between mitral inflow echocardiographic parameters and p-wave morphology with the accelerometer A4 signal amplitude. We also sought to identify clinical and echocardiographic predictors of optimal ambulatory AVS (≥85% of cardiac cycles). Forty-three patients undergoing Micra AV implant from June 2020 to March 2023 were prospectively enrolled. Baseline echocardiogram and 12-lead resting ECG were performed. Device follow-up was scheduled at 24 h, 1, 3, and 6 months and yearly after the implant. Ambulatory AVS was studied with a 24 h Holter monitor performed at 3 months follow-up in 35 patients who remained in VDD mode. A4 signal amplitude at 1 month correlated to peak A wave velocity (r = .376; p = .024) at echocardiogram, but no relationship was found with peak A' wave velocity, E/A, or E'/A' ratio. P-wave amplitude in lead I and aVF correlated to A4 signal amplitude at 1- and 3-months follow-up, respectively. Median AVS during 24 h of daily activities was 85.6 ± 7.6% and remained stable up to 100 bpm. Twenty-three out of 35 patients (65.7%) reached optimal ambulatory AVS. There was no association between mitral inflow echocardiographic parameters and optimal AVS. Diabetes (OR: 0.05, 95% CI: 0.01-0.47; p = .009) and chronic obstructive pulmonary disease (COPD) (OR: 0.06, 95% CI: 0.01-0.63; p = .019) strongly predicted ambulatory AVS <85%. CONCLUSIONS Diabetes and COPD should be considered when selecting candidates for Micra AV. Measurements of pulsed wave Doppler mitral inflow do not systematically reflect the behavior of the A4 signal amplitude.
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