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Steinwender C, Lercher P, Schukro C, Blessberger H, Prenner G, Andreas M, Kraus J, Ammer M, Stühlinger M. State of the art: leadless ventricular pacing : A national expert consensus of the Austrian Society of Cardiology. J Interv Card Electrophysiol 2019; 57:27-37. [PMID: 31863250 PMCID: PMC7036055 DOI: 10.1007/s10840-019-00680-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/02/2019] [Indexed: 01/25/2023]
Abstract
Background Cardiac pacing has been shown to improve quality of life and prognosis of patients with bradycardia for almost 60 years. The latest innovation in pacemaker therapy was miniaturization of generators to allow leadless pacing directly in the right ventricle. There is a long history and extensive experience of leadless ventricular pacing in Austria. However, no recommendations of national or international societies for indications and implantation of leadless opposed to transvenous pacing systems have been published so far. Results A national expert panel of skilled implanters gives an overview on the two utilized leadless cardiac pacing systems and highlights clinical advantages as well as current knowledge of performance and complication rates of leadless pacing. Furthermore, a national consensus for Austria is presented, based on recent studies and current know-how, specifically including indications for leadless pacing, management of infection, suggestions for qualification, and training of the operators and technical standards. Conclusions Leadless pacing systems can be implanted successfully with a low complication rate, if suggestions for indications and technical requirements are followed. Condensed abstract An overview of the two utilized leadless cardiac pacing systems is given, specifically highlighting clinical advantages as well as current knowledge of performance and complication rates. Furthermore, a national consensus for Austria is presented, specifically including indications for leadless pacing, management of infection, and suggestions for qualification and technical standards.
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Affiliation(s)
- C Steinwender
- Department of Cardiology and Internal Intensive Medicine, Kepler University Hospital, Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - P Lercher
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - C Schukro
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - H Blessberger
- Department of Cardiology and Internal Intensive Medicine, Kepler University Hospital, Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - G Prenner
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - M Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - J Kraus
- Universitätsklinik für Innere Medizin II, Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - M Ammer
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - M Stühlinger
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
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Ziacchi M, Palmisano P, Biffi M, Guerra F, Stabile G, Forleo GB, Zanotto G, D'Onofrio A, Landolina M, De Ponti R, Zoni Berisso M, Ricci RP, Boriani G. Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing). Expert Rev Med Devices 2019; 16:821-828. [PMID: 31348864 DOI: 10.1080/17434440.2019.1649134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters. Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation. Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous. Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators' majority want to disposition all kind of leads, although quadripolar leads are the favorites.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | | | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University , Ancona , Italy
| | | | | | | | | | | | - Roberto De Ponti
- Department of Heart and Vessels, Circolo Hospital, University of Insubria , Varese , Italy
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena , Italy
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Umamaheshwar KL, Singh AS, Sivakumar K. Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management. Indian Pacing Electrophysiol J 2018; 19:15-22. [PMID: 30508590 PMCID: PMC6354237 DOI: 10.1016/j.ipej.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/04/2022] Open
Abstract
Fontan surgery and its modifications have improved survival in various forms of univentricular hearts. A regular atrial rhythm with atrioventricular synchrony is one of the most important prerequisite for the long-term effective functioning of this preload dependent circulation. A significant proportion of these survivors need various forms of pacing for bradyarrhythmias, often due to sinus nodal dysfunction and sometimes due to atrioventricular nodal block. The diversion of the venous flows away from the cardiac chambers following this surgery takes away the simpler endocardial pacing options through the superior vena cava. The added risks of thromboembolism associated with endocardial leads in systemic ventricles have made epicardial pacing as the procedure of choice. However challenges in epicardial pacing include surgical adhesions, increased pacing thresholds leading to early battery depletion and frequent lead fractures. When epicardial pacing fails, endocardial lead placement is equally challenging due to lack of access to the cardiac chambers in Fontan circulation. This review discusses the univentricular heart morphologies that may warrant pacing, issues about epicardial pacing, different techniques for endocardial pacing in patients with disconnected superior vena cava, pacing in different modifications of Fontan surgeries, issues of systemic thromboembolism with endocardial leads, atrioventricular valve regurgitation attributed to pacing leads and device infections. In a vast majority of patients following Glenn shunt and Senning surgery, an epicardial pacing and lead replacement is always feasible though technically very difficult. This article highlights the different options of transatrial and transventricular endocardial pacing. Fontan surgery prolongs the mean survival of patients with univentricular hearts beyond 30 years. 9-20% of survivors need permanent pacing for bradyarrhythmias. Epicardial pacing is preferred as the first choice for permanent pacemaker. There is 20-40% failure of permanent pacing at 10 years due to high threshold, lead fractures. Repeated epicardial pacing with surgical revisions are difficult. Endocardial pacing involves special techniques. Manoeuvring through fenestrations,venous collaterals, hepatic veins, pulmonary valve or hybrid peratrial routes is needed. Systemic thromboembolism, endocarditis and systemic AV valve regurgitation should be prevented by meticulously measures.
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Focal stimulation of the sheep motor cortex with a chronically implanted minimally invasive electrode array mounted on an endovascular stent. Nat Biomed Eng 2018; 2:907-914. [DOI: 10.1038/s41551-018-0321-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/22/2018] [Indexed: 12/29/2022]
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