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Gao J, Zhang N, Zhang B, Sun M, Meng Z, Guo M, Wang R. A case report of left ventricular lead implantation via total three-dimensional transseptal puncture after tricuspid valve replacement. Front Cardiovasc Med 2023; 10:1237967. [PMID: 37965082 PMCID: PMC10642443 DOI: 10.3389/fcvm.2023.1237967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Ventricular lead implantation is relatively difficult for patients with bradyarrhythmia after tricuspid valve replacement. Right atrial (RA) abnormalities often occurred in patients with tricuspid valve disease; conventional coronary sinus (CS) lead implantation is not easy to operate. Therefore, it is necessary to develop a safe method for implanting LV endocardial leads in patients after tricuspid valve replacement. Case presentation A 76-year-old Asian woman who had been implanted with a metal tricuspid valve replacement 4 years ago was admitted to the Department of Cardiology for pacemaker implantation due to transient blackout related to persistent atrial fibrillation with long pauses. The patient's family rejected the surgical placement of an epicardial LV lead. Therefore, we first intended to operate LV lead implantation through the CS; however, the orifice of the CS was virtually difficult to seek. Ultimately, we utilized total 3-dimensional (T3D) transseptal puncture (TSP) under the guidance of the CARTO 3 system; thus, we implanted the LV endocardial lead, which contributed to the accurate puncture of the central fossa ovalis and ensured the safety of TSP in the case of RA enlargement. Meanwhile, the CARTO 3 system contributed to the localization of the LV lead to the LV free wall during implantation. All the intraoperative and postoperative pacemaker parameters were favorable; no intraoperative or postoperative complications occurred. Conclusions This case report may provide a novel surgical approach for LV lead implantation in patients who underwent tricuspid valve replacement or patients who may benefit from cardiac resynchronization therapy but failed to implant CS lead.
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Affiliation(s)
- Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Binghang Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Meng Sun
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhijun Meng
- Department of Clinical Laboratory, Shanxi Provincial People's Hospital of Shanxi Medical University, Taiyuan, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
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Marini M, Pannone L, Branzoli S, Quintarelli S, Coser A, Guarracini F, Bonmassari R, La Meir M, de Asmundis C. Video-assisted thoracoscopic epicardial pacing: A contemporary overview. Pacing Clin Electrophysiol 2023; 46:1215-1221. [PMID: 37676730 DOI: 10.1111/pace.14815] [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: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
Video-assisted thoracoscopic surgery (VATS) has revolutionized the approach and management of pulmonary and cardiac diseases, and its applications have significantly expanded in the last two decades. Beyond its established role in thoracic procedures, VATS has also emerged as a valuable technique for various electrophysiological procedures, including pacemaker implantations, ablation procedures, and left atrial appendage exclusion. This paper presents a thorough review of the existing literature on pacing procedures performed using a VATS approach. By analyzing and synthesizing the available studies, we aim to provide an in-depth understanding of the current knowledge and advancements in VATS-based pacing procedures. A key focus of this review is the detailed description of implantation techniques via a VATS approach.
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Affiliation(s)
- Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
- Heart Rhythm Management Centre, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stefano Branzoli
- Department of Cardiac Surgery, S. Chiara Hospital, Trento, Italy
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | - Mark La Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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3
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Takeda T, Tsubaki A, Ikeda Y, Kato R, Hotta K, Inoue T, Kojima S, Kanai R, Terazaki Y, Uchida R, Makita S. The impacts of preoperative frailty on readmission after cardiac implantable electrical device implantation. PLoS One 2022; 17:e0277115. [PMID: 36327285 PMCID: PMC9632810 DOI: 10.1371/journal.pone.0277115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Cardiac implantable electrical devices (CIED) such as pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapies are generally recommended for older patients and those with severe heart failure (HF). However, there is currently a lack of evidence on the relationship between frailty and readmission rates among patients with CIED. This study investigated whether preoperative frailty influenced readmission rates among patients with CIED over a one-year period following implantation. The study retrospectively analyzed 101 patients who underwent CIED implantations. To compare frailty-based differences in their characteristics and readmission rates, these participants were categorized into frailty and non-frailty groups via the modified frailty index (mFI). The frailty group had a significantly higher readmission rate than the non-frailty group (non-frailty group vs. frailty group = 1 vs. 8 patients: P < 0.05). Further, a multivariate analysis showed that frailty was a significant readmission factor. Based on individual analyses with/without histories of HF, the readmission rate also tended to be higher among individuals considered frail via the mFI (readmission rate in HF patients: non-frailty group vs. frailty group = 1 vs. 5 patients: P = 0.65; non-HF patients: non-frailty group vs. frailty group = 0 vs. 3 patients: P = 0.01). Participants with preoperative frailty showed higher readmission rates within a one-year period following implantation compared to those without preoperative frailty. This tendency was consistent regardless of HF history. The mFI may thus help predict readmission among patients with CIED.
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Affiliation(s)
- Tomonori Takeda
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- * E-mail: ,
| | - Atsuhiro Tsubaki
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuki Hotta
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Tatsuro Inoue
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Sho Kojima
- Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Department of Rehabilitation, Kisen Hospital, Katsushika, Tokyo, Japan
| | - Risa Kanai
- Department of Nursing, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yoshitaka Terazaki
- Department of Nursing, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ryusei Uchida
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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4
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A Solution Trick: Implantation of Coronary Sinus Lead Without Delivery System, A Case Series Study. COR ET VASA 2022. [DOI: 10.33678/cor.2021.097] [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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5
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Wu HY, Li SJ, Yang Z, Chen HC, You PH, Cheng G. A Novel Approach for Repetitive Dislocation of Transvenous Left Ventricular Leads During Cardiac Resynchronization Therapy Implantation by the Loop Technique. Front Cardiovasc Med 2022; 9:836514. [PMID: 35800169 PMCID: PMC9253391 DOI: 10.3389/fcvm.2022.836514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) for heart failure requires transvenous insertion of a left ventricular pacing lead through the coronary sinus. However, repeated intraoperative dislocations often occur. Therefore, we describe a novel technique that uses the loop technique to treat patients with repeated intraoperative dislocations during transvenous left ventricular lead implantation to stabilize the lead in its final position. In five patients with repeated intraoperative dislocation during transvenous left ventricular lead implantation, the loop technique was successfully used to stabilize the lead in its final position. The pacing and sensing parameters were satisfactory in all patients at implantation and 12 months post-operatively. Compared with the pre-operative values, the 12-month post-operative values for the left ventricular ejection fraction were significantly increased and the left ventricular end systolic dimension and left ventricular end diastolic dimension were significantly decreased (P < 0.05). The left ventricular ejection fraction of these 5 patients increased by more than 15%. CRT significantly improved the left ventricular structure and function of these 5 patients. During the 1-, 3-, 6-, and 12-month follow-ups, no left ventricular lead dislocations were observed. This loop technique is safe and effective and can be considered for repeated intraoperative dislocation during transvenous left ventricular lead implantation through the coronary sinus of a CRT device.
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Hu X, Xu H, Hassea SRA, Qian Z, Wang Y, Zhang X, Hou X, Zou J. Comparative efficacy of image-guided techniques in cardiac resynchronization therapy: a meta-analysis. BMC Cardiovasc Disord 2021; 21:255. [PMID: 34024286 PMCID: PMC8142495 DOI: 10.1186/s12872-021-02061-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
Background Several studies have illustrated the use of echocardiography, magnetic resonance imaging, and nuclear imaging to optimize left ventricular (LV) lead placement to enhance the response of cardiac resynchronization therapy (CRT) in heart failure patients. We aimed to conduct a meta-analysis to determine the incremental efficacy of image-guided CRT over standard CRT. Methods We searched PubMed, Cochrane library, and EMBASE to identify relevant studies. The outcome measures of cardiac function and clinical outcomes were CRT response, concordance of the LV lead to the latest sites of contraction (concordance of LV), heart failure (HF) hospitalization, mortality rates, changes of left ventricular ejection fraction (LVEF), and left ventricular end-systolic volume (LVESV). Results The study population comprised 1075 patients from eight studies. 544 patients underwent image-guided CRT implantation and 531 underwent routine implantation without imaging guidance. The image-guided group had a significantly higher CRT response and more on-target LV lead placement than the control group (RR, 1.33 [95% CI, 1.21 to 1.47]; p < 0.01 and RR, 1.39 [95% CI, 1.01 to 1.92]; p < 0.05, respectively). The reduction of LVESV in the image-guided group was significantly greater than that in the control group (weighted mean difference, − 12.46 [95% CI, − 18.89 to − 6.03]; p < 0.01). The improvement in LVEF was significantly higher in the image-guided group (weighted mean difference, 3.25 [95% CI, 1.80 to 4.70]; p < 0.01). Pooled data demonstrated no significant difference in HF hospitalization and mortality rates between two groups (RR, 0.89 [95% CI, 0.16 to 5.08]; p = 0.90, RR, 0.69 [95% CI, 0.37 to 1.29]; p = 0.24, respectively). Conclusions This meta-analysis indicates that image-guided CRT is correlated with improved CRT volumetric response and cardiac function in heart failure patients but not with lower hospitalization or mortality rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02061-y.
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Affiliation(s)
- Xiao Hu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China.,Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Hai Xu
- Department of Cardiology, Staten Island University Hospital / Northwell Health, 475 Seaview Drive, Staten Island, NY, 10305, USA
| | - Shameer Raaj Avishkar Hassea
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China
| | - Xinwei Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Nanjing, 210029, China.
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Okabe T, Augostini RS, Essandoh MK, Hummel JD. Percutaneous retrieval of an unanchored WiSE-CRT system left ventricular receiver electrode. HeartRhythm Case Rep 2020; 6:579-582. [PMID: 32983870 PMCID: PMC7498523 DOI: 10.1016/j.hrcr.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ralph S Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael K Essandoh
- Department of Anesthesiology, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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8
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Marini M, Branzoli S, Moggio P, Martin M, Belotti G, Molon G, Guarracini F, Coser A, Quintarelli S, Pederzolli C, Graffigna A, Penzo D, Valsecchi S, Bottoli MC, Pepi P, Bonmassari R, Droghetti A. Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video-assisted thoracoscopic technique: Long-term outcome. Clin Cardiol 2019; 43:284-290. [PMID: 31837030 PMCID: PMC7068064 DOI: 10.1002/clc.23300] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/10/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Epicardial placement of the left ventricular (LV) lead via a video-assisted thoracoscopic (VAT) approach is an alternative to the standard transvenous technique. HYPOTHESIS Long-term safety and efficacy of VAT and transvenous LV lead implantation are comparable. To test it, we reviewed our experience and we compared the outcomes of patients who underwent implantation with the two techniques. METHODS The VAT procedure is performed under general anesthesia, with oro-tracheal intubation and right-sided ventilation, and requires two 5 mm and one 15 mm thoracoscopic ports. After pericardiotomy at the spot of the epicardial target area, pacing measurements are taken and a spiral screw electrode is anchored at the final pacing site. The electrode is then tunneled to the pectoral pocket and connected to the device. RESULTS 105 patients were referred to our center for epicardial LV lead implantation. After pre-operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery. The remaining 100 underwent the procedure. LV lead implantation was successful in all patients (median pacing threshold 0.8 ± 0.5 V, no phrenic nerve stimulation) and cardiac resynchronization therapy was established in all but one patient. The median procedure time was 75 min. During a median follow-up of 24 months, there were no differences in terms of death, cardiovascular hospitalizations or device-related complications vs the group of 100 patients who had undergone transvenous implantation. Patients of both groups displayed similar improvements in terms of ventricular reverse remodeling and functional status. CONCLUSIONS Our VAT approach proved safe and effective, and is a viable alternative in the case of failed transvenous LV implantation.
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Affiliation(s)
| | - Stefano Branzoli
- Department of Cardiac Surgery, S. Chiara Hospital, Trento, Italy
| | - Paolo Moggio
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | - Carlo Pederzolli
- Department of Cardiac Surgery, S. Chiara Hospital, Trento, Italy
| | - Angelo Graffigna
- Department of Cardiac Surgery, S. Chiara Hospital, Trento, Italy
| | - Daniele Penzo
- Department of Anesthesiology, S. Chiara Hospital, Trento, Italy
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Sperzel J, Hamm C, Hain A. Leadless pacing. Herz 2018; 43:605-611. [PMID: 30255304 DOI: 10.1007/s00059-018-4752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Leadless self-contained intracardiac pacemakers were developed with the aim of abolishing the short- and long-term risk of lead- and pocket-related complications associated with transvenous devices. Leadless pacemakers promise minimally invasive procedures, long battery lives, and small amounts of foreign materials in the body. Experiences with the pioneering single-chamber devices have provided reasons for optimism about the future of the leadless concept. In the future, as more patients receive and live longer with implantable devices, the total risk of procedure- and lead-related complications is expected to increase, adding a sense of urgency to the need for leadless alternatives to transvenous pacemakers. This review surveys the performance of currently available leadless pacemakers as well as emerging new innovative adaptations and applications of the leadless concept.
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Affiliation(s)
- J Sperzel
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany. .,Electrophysiology/Device Therapies, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - C Hamm
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - A Hain
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
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10
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De Maria E, Ziacchi M, Diemberger I, Biffi M. Leadless left ventricular endocardial pacing: a real alternative or a luxury for a few? Cardiovasc Diagn Ther 2018; 8:530-533. [PMID: 30214871 DOI: 10.21037/cdt.2018.03.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Elia De Maria
- Arrhythmology Lab, Cardiology Unit, Ramazzini Hospital, Carpi (Modena), Italy
| | - Matteo Ziacchi
- Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Igor Diemberger
- Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Providencia R, Barra S, Papageorgiou N, Ioannou A, Rogers D, Wongwarawipat T, Falconer D, Duehmke R, Colicchia M, Babu G, Segal OR, Sporton S, Dhinoja M, Ahsan S, Ezzat V, Rowland E, Lowe M, Lambiase PD, Agarwal S, Chow AW. Dual-site right ventricular pacing in patients undergoing cardiac resynchronization therapy: Results of a multicenter propensity-matched analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1113-1120. [PMID: 28734025 DOI: 10.1111/pace.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dual-site right ventricular pacing (Dual RV) has been proposed as an alternative for patients with heart failure undergoing cardiac resynchronization therapy (CRT) with a failure to deliver a coronary sinus (CS) lead. Only short-term hemodynamic and echocardiographic results of Dual RV are available. We aimed to assess the long-term results of Dual RV and its impact on survival. METHODS Multicenter retrospective assessment of all CRT implants during a 12-year period. Patients with failed CS lead implantation, treated with Dual RV, were followed and assessed for the primary endpoint of all-cause mortality and/or heart transplant. A control group was obtained from contemporary patients using propensity matching for all available baseline variables. RESULTS Ninety-three patients were implanted with Dual RV devices and compared with 93 matched controls. During a median of 1,273 days (interquartile range 557-2,218), intention-to-treat analysis showed that all-cause mortality and/or heart transplant was higher in the Dual RV group (adjusted hazard ratio [HR] = 1.66, 95% confidence interval [CI] 1.12-2.47, P = 0.012). As-treated analysis yielded similar results (HR = 1.97, 95% CI 1.31-2.96, P = 0.001). Cardiac device-related infections occurred seven times more frequently in the Dual RV site group (HR = 7.60, 95% CI 1.51-38.33, P = 0.014). Among Dual RV nonresponders, four had their apical leads switched off, five required an epicardial LV lead insertion, a transseptal LV lead was implanted in two, and in nine patients, after reviewing the CS venogram, a new CS lead insertion was successfully attempted. CONCLUSION Dual RV pacing is associated with worse clinical outcomes and higher complication rates than conventional CRT.
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Affiliation(s)
| | - Sergio Barra
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Adam Ioannou
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | - Dominic Rogers
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | | | - Debbie Falconer
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | | | | | - Girish Babu
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | | | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Syed Ahsan
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | | | - Martin Lowe
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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12
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Transvenous versus open chest lead placement for resynchronization therapy in patients with heart failure: comparison of ventricular electromechanical synchronicity. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2017; 14:261-265. [PMID: 28663764 PMCID: PMC5483595 DOI: 10.11909/j.issn.1671-5411.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Transvenous lead placement is the standard approach for left ventricular (LV) pacing in cardiac resynchronization therapy (CRT), while the open chest access epicardial lead placement is currently the most frequently used second choice. Our study aimed to compare the ventricular electromechanical synchronicity in patients with heart failure after CRT with these two different LV pacing techniques. Methods We enrolled 33 consecutive patients with refractory heart failure secondly to dilated cardiomyopathy who were eligible for CRT in this study. Nineteen patients received transvenous (TV group) while 14 received open chest (OP group) LV lead pacing. Intra- and inter-ventricular electromechanical synchronicity was assessed by tissue Doppler imaging (TDI) before and one year after CRT procedure. Results Before CRT procedure, the mean QRS-duration, maximum time difference to systolic peak velocity among 12 left ventricle segments (LV Ts-12), standard deviation of time difference to systolic peak velocity of 12 left ventricle segments (LV Ts-SD), and inter-ventricular mechanical delay (IVMD) in OP and TV group were 166 ± 17 ms and 170 ± 21 ms, 391 ± 42 ms and 397 ± 36 ms, 144 ± 30 ms and 148 ± 22 ms, 58 ± 25 ms and 60 ± 36 ms, respectively (all P > 0.05). At one year after the CRT, the mean QRS-duration, LV Ts-12, LV Ts-SD, and IVMD in TV and OP group were 128 ± 14 ms and 141 ± 22 ms (P = 0.031), 136 ± 37 ms and 294 ± 119 ms (P = 0.023), 50 ± 22 ms and 96 ± 34 ms (P = 0.015), 27 ± 11 ms and 27 ± 26 ms (P = 0.86), respectively. The LV lead implantation procedure time was 53.4 ± 16.3 min for OP group and 136 ± 35.1 min for TV group (P = 0.016). The mean LV pacing threshold increased significantly from 1.7 ± 0.6 V/0.5 ms to 2.3 ± 1.6 V/0.5 ms (P < 0.05) in TV group while it remained stable in the OP group. Conclusions Compared to conventional endovascular approach, open chest access of LV pacing for CRT leads to better improvement of the intraventricular synchronization.
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Reddy VY, Miller MA, Neuzil P, Søgaard P, Butter C, Seifert M, Delnoy PP, van Erven L, Schalji M, Boersma LV, Riahi S. Cardiac Resynchronization Therapy With Wireless Left Ventricular Endocardial Pacing. J Am Coll Cardiol 2017; 69:2119-2129. [DOI: 10.1016/j.jacc.2017.02.059] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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14
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Trans-Fontan baffle placement of an endocardial systemic ventricular pacing lead. HeartRhythm Case Rep 2017; 3:129-132. [PMID: 28491786 PMCID: PMC5420057 DOI: 10.1016/j.hrcr.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy.
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Affiliation(s)
- Advay G Bhatt
- Arrhythmia Institute, The Valley Health System, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA
| | - Jonathan S Steinberg
- Arrhythmia Institute, The Valley Health System, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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McALOON CJ, Anderson BM, Dimitri W, Panting J, Yusuf S, Bhudia SK, Osman F. Long-Term Follow-Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2016; 39:1052-1060. [PMID: 27501471 DOI: 10.1111/pace.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/20/2016] [Accepted: 07/31/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy is unsuccessful in 5-10% of reported cases. These patients may benefit from isolated surgical placement of an epicardial LV lead via minithoracotomy approach. AIM To evaluate the success of this approach at long-term follow-up. METHODS Retrospective evaluation of all consecutive patients undergoing isolated epicardial LV lead placement after failed transvenous attempt over a 6-year period. Data collected on baseline parameters, procedural details, and outcome at follow-up (hospital stay, complications, mortality, and clinical response). RESULTS Forty-two patients underwent epicardial lead implant. Five died within 1 year (11.9%): two (4.8%) died within 30-days post op (one from intraoperative hemorrhage, the other from multiple organ failure); 39 (95.1%) were admitted to the high dependency unit and transferred to the ward <24 hours. Median hospital stay was 3.4 ± 1.9 days. The overall complication rate was 17.5% (n = 7): 15.0% (n = 6) short term and 2.5% (n = 1) long term; these included three (7.5%) LV noncapture events all treated with reprogramming. There were two (5.0%) wound infections requiring oral antibiotics and two (5.0%) device infections requiring intravenous antibiotics (one had device resiting, the other developed septic shock requiring intensive care admission). Assessment of clinical response was possible in 34 (81.0%) at follow-up: 21 (61.8%) were responders and 13 (28.2%) nonresponders with no significant differences between these groups; no clinical predictors of response were identified. CONCLUSION Isolated epicardial LV lead implant using minithoracotomy is relatively safe and effective at successful LV pacing. Response rate and postoperative recovery at long-term follow-up are reasonable in these high-risk patients.
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Affiliation(s)
| | | | - Wadih Dimitri
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Jonathan Panting
- Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - Shamil Yusuf
- Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - Sunil K Bhudia
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, UK.
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17
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Abstract
Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy.
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Affiliation(s)
- Advay G Bhatt
- Arrhythmia Institute, The Valley Health System, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA
| | - Jonathan S Steinberg
- Arrhythmia Institute, The Valley Health System, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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18
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Miller MA, Neuzil P, Dukkipati SR, Reddy VY. Leadless Cardiac Pacemakers. J Am Coll Cardiol 2015; 66:1179-89. [PMID: 26337997 DOI: 10.1016/j.jacc.2015.06.1081] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine, New York, New York
| | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine, New York, New York.
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20
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Calvo N, Arguedas H, Canepa JP, García-Bolao I. Endocardial left ventricular lead placement from the left subclavian vein approach. ACTA ACUST UNITED AC 2014; 16:1857-9. [DOI: 10.1093/europace/euu123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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