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Ueyama HA, Miyamoto Y, Hashimoto K, Watanabe A, Kolte D, Latib A, Kuno T, Tsugawa Y. Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024:S1936-8798(24)00812-4. [PMID: 39023453 DOI: 10.1016/j.jcin.2024.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Evidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. METHODS Medicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. RESULTS A total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). CONCLUSIONS Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuyuki Watanabe
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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2
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Hofer D, Perucchini F, Blessberger H, Steinwender C, Zehetleitner S, Molitor N, Saguner AM, El-Chami MF, Black G, Schiavone M, Forleo G, Gasperetti A, Steffel J, Noti F, Haeberlin A, Breitenstein A. Electrocardiographic predictors of atrial mechanical sensing in leadless pacemakers. Heart Rhythm 2024; 21:1072-1080. [PMID: 38432424 DOI: 10.1016/j.hrthm.2024.02.061] [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: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Leadless pacemakers (LPs) capable of VDD pacing allow for atrioventricular synchrony through mechanical sensing of atrial contraction. However, mechanical sensing is less reliable and less predictable than electrical sensing. OBJECTIVE The purpose of this study was to evaluate P-wave amplitude during sinus rhythm from preoperative 12-lead electrocardiograms (ECGs) as a predictor for atrial mechanical sensing in patients undergoing VDD LP implantation. METHODS Consecutive patients undergoing VDD LP implantation were included in this 2-center prospective cohort study. ECG parameters were evaluated separately and in combination for association with the signal amplitude of atrial mechanical contraction (A4). RESULTS Eighty patients (median age 82 years; female 55%; mean body mass index [BMI] 25.8 kg/m2) were included in the study and 61 patients in the A4 signal analysis (19 patients in VVI mode during follow-up). Absolute (aVL, aVF, V1, V2) and BMI-adjusted (I, II, aVL, aVF, aVR, V1, V2) P-wave amplitudes from baseline ECGs demonstrated a statistically significant positive correlation with A4 signal amplitude (all P <.05). A combined P-wave signal amplitude of at least 0.2 mV in V1 and aVL was predictive, with specificity of 83% (95% confidence interval 67%-100%) for A4 signal ≥1 m/s2. We found a significant correlation of A4 signal amplitude and overall atrioventricular synchrony (P = .013). CONCLUSION P-wave amplitudes in ECG leads aVL and V1 can predict A4 signal amplitude in patients with VDD LP and therefore the probability of successful AV synchronous pacing.
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Affiliation(s)
- Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Fabrizio Perucchini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Samantha Zehetleitner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Molitor
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - George Black
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giovanni Forleo
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Xu F, Meng L, Lin H, Xu W, Guo H, Peng F. Systematic review of leadless pacemaker. Acta Cardiol 2024; 79:284-294. [PMID: 37961771 DOI: 10.1080/00015385.2023.2276537] [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] [Received: 05/24/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
Conventional pacing systems consist of a pacemaker and one or more leads threaded from the device pocket through veins into the heart conducting the pacing therapy to the desired pacing site. Although these devices are effective, approximately one in eight patients treated with these traditional pacing systems experiences a complication attributed to the pacemaker pocket or leads. With the technological advances in electronics, leadless pacemakers that small enough to implant within the heart were introduced. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing including complications related to leads or pacemaker pockets. This review aims to provide an overview of advantages of leadless pacemaker, complications and limitations of leadless pacemaker, leadless pacemaker candidate, and future directions of this promising technology.
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Affiliation(s)
- Fukang Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Liping Meng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hui Lin
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiyuan Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hangyuan Guo
- Shaoxing Wen li Medical College, Shaoxing, China
| | - Fang Peng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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Silva RRP, Magalhães CJ, Silva RSVD, Tavares de Albuquerque AL, Montenegro ST, Alencar Neto JND. Accelerated idioventricular rhythm as anginous substrate in elderly: Report of an unprecedented case. HeartRhythm Case Rep 2024; 10:217-221. [PMID: 38496744 PMCID: PMC10943551 DOI: 10.1016/j.hrcr.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Rodrigo Rufino Pereira Silva
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Carolina Jerônimo Magalhães
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Rafael Silvestre Vieira da Silva
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Afonso Luiz Tavares de Albuquerque
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Sérgio Tavares Montenegro
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
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Laksono S, Yuniadi Y, Soesanto AM, Raharjo SB, Lisnawati, Bardosono S, Angkasa IS, Hosanna C. Comparison of Global Longitudinal Strain in Dual-chamber versus Ventricular Pacemaker in Complete Heart Block. J Cardiovasc Echogr 2024; 34:14-18. [PMID: 38818320 PMCID: PMC11135818 DOI: 10.4103/jcecho.jcecho_78_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 06/01/2024] Open
Abstract
Context Bradycardia caused by total atrioventricular block (TAVB) is treated by implantation of permanent pacemakers (PPMs) in either dual-chamber (DDD) versus ventricular (VVI) pacing modes. DDD is considered a more physiological pacing mode than VVI as it avoids atrioventricular dyssynchrony. However, previous trials have failed to demonstrate the superiority of DDD in improving quality of life and morbidity. Aims This study aims to provide postpacemaker function of the left ventricle (LV) measured with global longitudinal strain (GLS), in TAVB patients. Settings and Design This is a comparative study; samples included in the study are adult TAVB patients undergoing PPM implantation, without significant heart function, and structural abnormality. Echocardiographic parameters are obtained before, after 1 month, and after 3 months post-PPM. Subjects and Methods A total of 98 TAVB patients undergoes PPM implantation during the study period, 55 patients were excluded, and in the end, only 43 patients fulfill the inclusion criteria. Statistical Analysis Used Baseline data between DDD and VVI are compared using unpaired t-test. Statistical significance 1 month post-PPM and 3 months post-PPM is analyzed using paired t-test. Results There were no significant differences between both groups at baseline. However, significant GLS changes are observed 1 month after PPM in the VVI group (P = 0.002), but no significant change was observed in the DDD group even after 3 months (P = 0.055). Conclusions In our study, we conclude that DDD is superior in maintaining LV function in the short term in TAVB patients after PPM implantation.
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Affiliation(s)
- Sidhi Laksono
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Prof. Dr. Hamka Muhammadiyah University, Banten, Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Harapan Kita National Cardiovascular Center, West Jakarta, Indonesia
| | - Amiliana Mardiani Soesanto
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | - Sunu Budhi Raharjo
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | - Lisnawati
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | - Saptawati Bardosono
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | | | - Cliffian Hosanna
- Faculty of Medicine, Tarumanagara University, West Jakarta, Indonesia
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Zeriouh S, Sousonis V, Menè R, Boveda S, Voglimacci-Stephanopoli Q, Combes S. Case Report: A leadless and endovascular pacemaker teamwork. Front Cardiovasc Med 2023; 10:1287506. [PMID: 38028465 PMCID: PMC10666049 DOI: 10.3389/fcvm.2023.1287506] [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: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cardiac Implantable Electronic Device infections increase short- and long-term mortality, along with healthcare costs. Leadless pacemakers (PM) were developed to overcome pocket- and minimize lead-related complications in selected high-risk patients. Recent advancements enable leadless devices to mechanically detect atrial activity, facilitating atrioventricular (AV) synchronous stimulation. Case summary A 90-year-old woman, implanted with a dual-chamber pacemaker eight years ago due to sinus node dysfunction, presented with syncope. A diagnosis of complete AV block, in the setting of ventricular lead dysfunction was made. Due to a high risk of infection, the patient was implanted with a leadless PM capable of maintaining AV synchrony in VDD mode (MICRA™ model MC1AVR1). The transvenous PM was programmed to AAI-R mode to drive the atria, which, in turn, triggered the leadless PM to stimulate the ventricles. At six month follow-up, the AV synchrony rate was 85%. Conclusion The combination of classic atrial pacing with leadless ventricular stimulation can be used in high-risk patients to reduce the risk of complications, in the setting of ventricular lead dysfunction. In this manner, AV synchrony can be maintained, improving hemodynamic parameters and quality of life. Low sinus rate variability at rest is essential to achieve a high AV synchrony rate in such cases.
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Affiliation(s)
| | | | | | | | | | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
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7
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Reddy VY, Neuzil P, Booth DF, Knops RE, Doshi RN, Rashtian M, Exner DV, Banker RS, Nair D, Hadadi CA, Badie N, Yang W, Ligon D, Ip JE. Dual-Chamber Leadless Pacing: Atrioventricular Synchrony in Preclinical Models of Normal or Blocked Atrioventricular Conduction. Heart Rhythm 2023:S1547-5271(23)02104-5. [PMID: 37075958 DOI: 10.1016/j.hrthm.2023.04.005] [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: 02/16/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Dual-chamber leadless pacemakers (LP) require robust communication between distinct right atrial (RA) and right ventricular (RV) LPs to achieve atrioventricular (AV) synchrony. OBJECTIVE This preclinical study evaluated a novel, continuous implant-to-implant (i2i™) communication methodology for maintaining AV-synchronous, dual-chamber DDD(R) pacing by the 2 LPs. METHODS RA and RV LPs were implanted and paired in 7 ovine subjects, 4 of 7 with induced complete heart block. AV synchrony (% AV intervals <300 ms) and i2i communication success (% successful i2i transmissions between LPs) were evaluated acutely and chronically. During acute testing, 12-lead ECG and LP diagnostic data were collected from 5-minute recordings, in 4 postures and 2 rhythms (AP-VP and AS-VP or AP-VS and AS-VS) per subject. Chronic i2i performance was evaluated through 23 weeks post-implant (final i2i evaluation period: week 16-23). RESULTS Acute AV synchrony and i2i communication success across multiple postures and rhythms were 100.0% [100.0-100.0] (median [interquartile range]) and 99.9% [99.9-99.9], respectively. AV synchrony and i2i success rates did not differ across postures (P=0.59, P=0.11) or rhythms (P=1.00, P=0.82). During the final i2i evaluation period, the overall i2i success was 98.9% [98.1-99.0]. CONCLUSION Successful AV-synchronous, dual-chamber DDD(R) leadless pacing using a novel, continuous, wireless communication modality was demonstrated across variations in posture and rhythm in a preclinical model.
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Affiliation(s)
- Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Na Homolce Hospital, Prague, Czech Republic.
| | | | | | | | - Rahul N Doshi
- HonorHealth Research Institute, Scottsdale, Arizona, USA
| | | | - Derek V Exner
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | | | - Devi Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | | | | | | | | | - James E Ip
- Weill Cornell Medical Center, New York, New York, USA
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8
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Chanthanamuthu R, Ramasamy S, Jain A, Anantharaj A, Pillai AA, Satheesh S, Selvaraj RJ. Short Term Outcomes with Dual Chamber versus Single Chamber Pacing for Atrioventricular Block - A Crossover Trial. Indian Heart J 2022; 74:335-337. [PMID: 35667401 PMCID: PMC9453048 DOI: 10.1016/j.ihj.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
A total of 42 patients were studied for primary outcomes of quality of life and 6MWD between VVIR and DDD modes. At end of 2 months after device implantation, randomization was done and the device was programmed to VVIR or DDD modes. At the end of 2 months in this mode QOL and functional was assessed and the patient was switched to other mode. The same protocol was followed at the end of 2 months. We found no difference in functional capacity and quality of life between the two pacing modes. None of the patients developed pacemaker syndrome and there was no preference for any of the modes.
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Affiliation(s)
- Ragavendra Chanthanamuthu
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sakthivel Ramasamy
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ashish Jain
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Avinash Anantharaj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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Kowlgi GN, Tseng AS, Tempel ND, Henrich MJ, Venkatachalam KL, Scott L, Shen WK, Deshmukh AJ, Mbbs MM, Lee HC, Asirvatham SJ, Friedman PA, Cha YM, Mulpuru SK. A Real-world Experience of Atrioventricular Synchronous Pacing with Leadless Ventricular Pacemakers. J Cardiovasc Electrophysiol 2022; 33:982-993. [PMID: 35233867 DOI: 10.1111/jce.15430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
AIMS The MicraTM transcatheter pacing system (TPS) (Medtronic) is the only leadless pacemaker that promotes atrioventricular (AV) synchrony via accelerometer-based atrial sensing. Data regarding the real-world experience with this novel system are scarce. We sought to characterize patients undergoing MicraTM -AV implants, describe percentage AV synchrony achieved, and analyze the causes for suboptimal AV synchrony. METHODS In this retrospective cohort study, electronic medical records from 56 consecutive patients undergoing MicraTM -AV implants at the Mayo Clinic sites in Minnesota, Florida, and Arizona with a minimum follow-up of 3 months were reviewed. Demographic data, comorbidities, echocardiographic data, and clinical outcomes were compared among patients with and without atrial synchronous-ventricular pacing (AsVP) ≥70%. RESULTS Sixty-five percent of patients achieved AsVP ≥70%. Patients with adequate AsVP had smaller body mass indices, a lower proportion of congestive heart failure, and prior cardiac surgery. Echocardiographic parameters and procedural characteristics were similar across the two groups. Active device troubleshooting was associated with higher AsVP. The likely reasons for low AsVP were small A4-wave amplitude, high ventricular pacing burden, and inadequate device reprogramming. Importantly, in patients with low AsVP, subjective clinical worsening was not noted during follow-up. CONCLUSION With the increasing popularity of leadless PM, it is paramount for device implanting teams to be familiar with common predictors of AV synchrony and troubleshooting with MicraTM -AV devices. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Andrew S Tseng
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathan D Tempel
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark J Henrich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Hon-Chi Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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10
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Laksono S, Setianto B, Iqbal M, Prawara AS. Understanding Pacemaker-Induced Cardiomyopathy Incidence and Predictors in Patients with Right Ventricular Pacing: A Systematic Review. Int J Angiol 2022; 31:10-15. [PMID: 35221847 DOI: 10.1055/s-0041-1735206] [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: 10/20/2022] Open
Abstract
This study aimed to figure out the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients with right ventricular (RV) pacing. We systematically searched in PubMed on March 18, 2020, for English language abstract and full-article journals, using the following criteria: pacemaker induced cardiomyopathy AND right ventricular AND pacemaker AND patients AND human NOT implantable cardioverter defibrillator NOT ICD NOT animal. Four studies were included in this review after filtering 35 studies through year of publication and abstract selection. The average PICM incidence from 1,365 patients included from the four studies was 10.7 to 13.7%. One study stated that preimplantation left ventricular ejection fraction (LVEF) was the predictor for the development of PICM. Three studies mentioned that RV pacing burden was the predictor for the development of PICM. However, the percentage differ in three studies: ≥20, >40, and 60%. In addition, one of the studies also included interventricular dyssynchrony as another predictor. The incidence of PICM in patients with RV pacing ranged from 10.7 to 13.7%. Preimplantation LVEF, interventricular dyssynchrony, and burden of RV pacing are reported as the predictors for the development of PICM in patients with RV pacing.
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Affiliation(s)
- Sidhi Laksono
- Department of Cardiology and Vascular Medicine, RS Pusat Pertamina, South Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Muhammadiyah Prof. Dr. Hamka, Tangerang, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, National Heart Center of Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ananta Siddhi Prawara
- Department of Emergency Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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Ellis CR, King N. Amulet™ Shines and Protects; Pacing Battle Intensifies with "More Leads or No Leads"? J Innov Card Rhythm Manag 2022; 13:4833-4839. [PMID: 35127236 PMCID: PMC8812483 DOI: 10.19102/icrm.2022.130110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Nicholas King
- Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
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12
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Gill J. Emerging Technologies in Electrophysiology: From Single Chamber to Biventricular Leadless Pacemakers. Cardiology 2022; 147:179-190. [PMID: 35038698 DOI: 10.1159/000521976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transvenous pacemakers have been shown to improve quality of life and mortality in patients with bradycardia and cardiac conduction blocks. However, they possess inevitable drawbacks as they have a relatively high incidence of lead and device pocket-related complications. Therefore, leadless pacemakers have emerged as a solution to reduce the complications seen with conventional pacemakers. However, there have been no clinical trials to date comparing transvenous to leadless pacemakers. SUMMARY Currently, the Micra TPS or AV device has been approved for commercial use worldwide but is limited to single-chamber pacing with single or dual-chamber sensing. Although the leadless pacemaker, Nanostim, was initially promising, it has been recalled due to concerns of battery failures and is no longer approved in Europe. In addition, the lack of defibrillation capabilities with leadless pacemakers has been a limiting factor; therefore, a leadless pacemaker with the already approved subcutaneous cardioverter-defibrillator system is currently being studied in humans. Moreover, the WiSE-CRT device has been approved in Europe, with the capabilities for leadless cardiac resynchronization therapy (CRT), to provide CRT for patients with unsuitable coronary sinus anatomy. Furthermore, retrieval of leadless pacemakers has been an area of concern; however, clinic data has signaled towards safe extraction of these devices with minimal complications. Key messages: This review will encompass the current literature regarding clinical safety and outcomes of these novel leadless pacemakers and discuss the evolving technologies in the field of cardiac pacing.
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Affiliation(s)
- Jashan Gill
- Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
- Department of Medicine, Northwestern Medicine McHenry Hospital, McHenry, Illinois, USA
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A novel and practical technique to facilitate lead insertion at the His bundle region. J Interv Card Electrophysiol 2021; 66:531-537. [PMID: 34013426 DOI: 10.1007/s10840-021-00941-z] [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: 08/07/2020] [Accepted: 01/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND His bundle (HB) pacing techniques are challenging and time-consuming. This is primarily due to the limitations in locating the relatively small area of the HB body for pacing. METHODS Permanent HB pacing was performed in 133 consecutive patients with symptomatic bradycardia. A right atrial septo-gram (RAS) was performed in all patients to locate the HB. Briefly, 8-10 cc of contrast was injected through the Medtronic C315HIS delivery sheath while fluoroscopy cine runs were obtained in the RAO 15-20° projection. The images obtained provided the visualization of an approximately 90° angle composed by the medial aspect of the tricuspid valve annulus (TVA) anteriorly and the superior aspect of the interatrial septum superiorly. The apex of this angle coincides with the tip of the triangle of Koch (TK), where the HB body is usually located. A Medtronic SelectSecure™ MRI SureScan™ Model 3830 lead was then advanced and directed towards this area. The HB was mapped using pace mapping and unipolar recordings from the lead tip. RESULTS Localization of the apex of the TK/HB body with the RAS was successful in all patients. The overall acute success of inserting the lead at the HB was 95%. CONCLUSION This study demonstrated that our method of utilizing a RAS to facilitate the localization the HB body proved to be safe and efficient in achieving permanent HB pacing with a success rate higher than previously reported.
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Co ML, Khouzam JP, Pour-Ghaz I, Minhas S, Basu-Ray I. Emerging Technologies in Cardiac Pacing From Leadless Pacers to Stem Cells. Curr Probl Cardiol 2021; 46:100797. [PMID: 33561694 DOI: 10.1016/j.cpcardiol.2021.100797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/28/2023]
Abstract
Modern pacemakers can sense and pace multiple chambers of the heart. These pacemakers have different modes and features to optimize atrioventricular synchrony and promote intrinsic conduction. Despite recent advancements, current pacemakers have several drawbacks that limit their feasibility. In this review article, we discuss several of these limitations and detail several emerging technologies in cardiac pacing aimed to solve some of these limitations. We present several technological advancements in cardiac pacing, including the use of leadless pacemakers, physiologic pacing, battery improvements, and bioartificial pacemakers. More research still needs to be done in testing the safety and efficacy of these new developments.
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Affiliation(s)
- Michael Lawren Co
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA
| | | | - Issa Pour-Ghaz
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Sheharyar Minhas
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, TN
| | - Indranill Basu-Ray
- Arrythmia Service, Department of Cardiology, Memphis VA Medical Center, The University of Memphis, Memphis, TN.
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Abstract
Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.
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Predictors of atrial mechanical sensing and atrioventricular synchrony with a leadless ventricular pacemaker: Results from the MARVEL 2 Study. Heart Rhythm 2020; 17:2037-2045. [DOI: 10.1016/j.hrthm.2020.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
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Smith B, Ashton L. Extreme pacemaker reel syndrome in an elderly patient with cognitive impairment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:353-357. [PMID: 32207647 DOI: 10.12968/bjon.2020.29.6.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Twiddler's syndrome is a rare cause of pacemaker failure, where patient manipulation of the pulse generator results in lead dislodgement or retraction. Variations in manifestation have been identified including reel syndrome, where rotation occurs around the transverse axis resulting in coiling of the leads, and ratchet syndrome where arm movement results in lead displacement. Device manipulation leading to device failure has been documented in up to 1.7% of implants, particularly in patients with large pockets or mental disorders. Such complications have serious consequences, particularly in pacing-dependent patients where loss of capture may result in asystole. This article reviews the case of an 84-year-old patient presenting at 8-month pacemaker follow-up in complete heart block with no evidence of pacemaker function.
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Affiliation(s)
- Bethany Smith
- Cardiac Physiologist, North Cumbria University Hospital
| | - Lisa Ashton
- Lecturer BSc Healthcare Science (Cardiac Physiology), School of Medicine, University of Leeds
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Atrioventricular Synchronous Pacing Using a Leadless Ventricular Pacemaker. JACC Clin Electrophysiol 2020; 6:94-106. [DOI: 10.1016/j.jacep.2019.10.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
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Garweg C, Splett V, Sheldon TJ, Chinitz L, Ritter P, Steinwender C, Lemme F, Willems R. Behavior of leadless AV synchronous pacing during atrial arrhythmias and stability of the atrial signals over time-Results of the MARVEL Evolve subanalysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:381-387. [PMID: 30687931 DOI: 10.1111/pace.13615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The MARVEL study demonstrated at a single time point that accelerometer (ACC)-based atrial sensing improves atrioventricular (AV) synchrony (AVS) in patients with AV block and a Micra pacemaker (Medtronic, Minneapolis, MN, USA). The purpose of the MARVEL Evolve substudy was to assess the performance over time. METHODS This prospective single-center study compared AVS and ACC signals at two visits ≥6 months apart. Custom software was temporarily downloaded into the Micra at each visit and AVS was measured during 30 min at rest. RESULTS Nine patients from the MARVEL study were enrolled. The mean (±standard deviation) age was 82.3 ± 6.0 years old, 67% were male, and a Micra was implanted for 6.0 ± 6.4 months. High-degree AV block was present in four patients, whereas five with predominantly intrinsic conduction required intermittent pacing for bradycardia. The mean interval between visits was 7.1 ± 0.6 months. Seven patients had normal sinus node function at both visits and were included in a paired analysis. Both ACC signal amplitude (visit 2-visit 1 = 1.4 mG; 95% confidence interval [CI] [-25.8 to 28.4 mG]; P = 0.933) and AVS (visit 1: 90.8%, 95% CI [72.4, 97.4] and visit 2: 91.4%, 95% CI [63.8, 98.5]; P = 0.740) remained stable. Three patients had spontaneous atrial tachycardia. During atrial fibrillation, no atrial contraction was detected or tracked. During atrial flutter, intermittent tracking resulted in a ventricular rate of 60 ± 8 beats per minute (bpm); there was no ventricular pacing >100 bpm. CONCLUSION ACC signals amplitude and performance of AVS pacing were stable over time. During atrial arrhythmias, the AV synchronous pacing mode behaved safely.
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Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Philippe Ritter
- Hopital Du Haut Leveque, University Hospital of Bordeaux, Pessac, France
| | | | | | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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Leadless pacemakers - The path to safer pacing? Indian Heart J 2019; 71:431-433. [PMID: 32248913 PMCID: PMC7136320 DOI: 10.1016/j.ihj.2019.11.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/28/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Abstract
Endocardial transvenous permanent pacemakers (TVPs) are a mainstay within cardiology and used to treat a range of bradyarrhythmias. However, their use is associated with potential complications both at the time of implantation and longer term. The concept of a leadless pacemaker, where a self-contained device is placed within the right ventricle, has obvious attractions. Two leadless systems have been developed, though only one is currently available. Results from clinical trials have been promising but a number of hurdles need to be circumvented before leadless devices can usurp TVPs. At present, use is restricted to specialist centres, for a limited indication and for patients in whom conventional implantation is contraindicated. This article provides a contemporary critique of design types, evidence base and existing limitations of this nascent technology.
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Response to atrial arrhythmias in an atrioventricular synchronous ventricular leadless pacemaker: A case report in a paroxysmal atrial fibrillation patient. HeartRhythm Case Rep 2018; 4:561-563. [PMID: 30581731 PMCID: PMC6301888 DOI: 10.1016/j.hrcr.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Chinitz L, Ritter P, Khelae SK, Iacopino S, Garweg C, Grazia-Bongiorni M, Neuzil P, Johansen JB, Mont L, Gonzalez E, Sagi V, Duray GZ, Clementy N, Sheldon T, Splett V, Stromberg K, Wood N, Steinwender C. Accelerometer-based atrioventricular synchronous pacing with a ventricular leadless pacemaker: Results from the Micra atrioventricular feasibility studies. Heart Rhythm 2018; 15:1363-1371. [PMID: 29758405 DOI: 10.1016/j.hrthm.2018.05.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Micra is a leadless pacemaker that is implanted in the right ventricle and provides rate response via a 3-axis accelerometer (ACC). Custom software was developed to detect atrial contraction using the ACC enabling atrioventricular (AV) synchronous pacing. OBJECTIVE The purpose of this study was to sense atrial contractions from the Micra ACC signal and provide AV synchronous pacing. METHODS The Micra Accelerometer Sensor Sub-Study (MASS) and MASS2 early feasibility studies showed intracardiac accelerations related to atrial contraction can be measured via ACC in the Micra leadless pacemaker. The Micra Atrial TRacking Using A Ventricular AccELerometer (MARVEL) study was a prospective multicenter study designed to characterize the closed-loop performance of an AV synchronous algorithm downloaded into previously implanted Micra devices. Atrioventricular synchrony (AVS) was measured during 30 minutes of rest and during VVI pacing. AVS was defined as a P wave visible on surface ECG followed by a ventricular event <300 ms. RESULTS A total of 64 patients completed the MARVEL study procedure at 12 centers in 9 countries. Patients were implanted with a Micra for a median of 6.0 months (range 0-41.4). High-degree AV block was present in 33 patients, whereas 31 had predominantly intrinsic conduction during the study. Average AVS during AV algorithm pacing was 87.0% (95% confidence interval 81.8%-90.9%), 80.0% in high-degree block patients and 94.4% in patients with intrinsic conduction. AVS was significantly greater (P <.001) during AV algorithm pacing compared to VVI in high-degree block patients, whereas AVS was maintained in patients with intrinsic conduction. CONCLUSION Accelerometer-based atrial sensing is feasible and significantly improves AVS in patients with AV block and a single-chamber leadless pacemaker implanted in the right ventricle.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lluis Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Gabor Z Duray
- Military Hospital-State Health Center, Budapest, Hungary
| | | | | | | | | | | | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Linz, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
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Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats. Sci Rep 2017; 7:5931. [PMID: 28725029 PMCID: PMC5517524 DOI: 10.1038/s41598-017-06197-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023] Open
Abstract
Biventricular pacing is an important modality to improve left ventricular (LV) synchronization and long-term function. However, the biological effects of this treatment are far from being elucidated and existing animal models are limited and demanding. Recently, we introduced an implanted device for double-site epicardial pacing in rats and echocardiographically demonstrated favorable effects of LV and biventricular (LV-based) pacing modes typically observed in humans. Here, this new animal model was further characterized. Electrodes were implanted either on the right atria (RA) and right ventricle (RV) or on the RV and LV. Following recovery, rats were either used for invasive hemodynamic measurements (pressure-volume analysis) or exposed to sustained RV vs. biventricular tachypacing for 3 days. RV pacing compromised, while LV-based pacing modes markedly enhanced cardiac performance. Changes in LV performance were associated with prominent compensatory changes in arterial resistance. Sustained RV tachypacing increased the electrocardiogram QTc interval by 7.9 ± 3.1 ms (n = 6, p < 0.05), dispersed refractoriness between the right and left pacing sites and induced important molecular changes mainly in the early-activated septal tissue. These effects were not observed during biventricular tachypacing (n = 6). Our results demonstrate that the rat is an attractive new model to study the biological consequences of LV dyssynchrony and resynchronization.
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Algazzar AS, Katta AA, Ahmed KS, Elkenany NM, Ibrahim MA. Changes in Left Ventricular Global and Regional Longitudinal Strain During Right Ventricular Pacing. Cardiol Res 2016; 7:17-24. [PMID: 28197264 PMCID: PMC5295530 DOI: 10.14740/cr454w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 01/23/2023] Open
Abstract
Background Our study aimed to demonstrate the short-term impacts of right ventricular apical pacing (RVAP) and right ventricular septal pacing (RVSP) on left ventricular (LV) regional longitudinal strain (RLS) and global longitudinal strain (GLS) in patients with preserved ejection fraction (EF). LV strain and functions may be altered by RVAP. RVSP might be a better alternative. The detrimental effect of right ventricular (RV) pacing may be mediated by regional LV impairment. Methods Sixty-two patients indicated for permanent pacemaker implantation and preserved LV systolic function were included. Dual chamber pacemakers were implanted in all patients. Patients were divided into two groups according to RV lead position: group A (RVAP, n = 32) and group B (RVSP, n = 30). Patients were examined at baseline and after 6 months of implantation for LV systolic functions, global and regional strain by echocardiography and 2D speckle tracking echocardiography. Results Paced QRS duration was significantly shorter in group B compared to group A patients (P = 0.02). Regarding ventricular strain, there was no statistically significant difference between both groups at baseline measurements in comparisons of GLS, relative apical longitudinal strain (rALS) and RLS (P > 0.05). In contrast, there was statistically significant difference between both groups in results of GLS (P = 0.01) at 6 months. In addition, RLSs in septal, apical and rALS were affected after 6 months with P values of 0.02, 0.03 and 0.03, respectively. Conclusion RVAP appears to worsen GLS more than RVSP, and the resultant decrease in apical strain is most correlated region to decrease in GLS.
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Affiliation(s)
| | - Azza Ali Katta
- Cardiology Department, National Heart Institute, Cairo, Egypt
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Fanourgiakis J, Simantirakis E, Maniadakis N, Kanoupakis E, Chrysostomakis S, Kourlaba G, Chlouverakis G, Vardas P. Complications Related to Cardiac Rhythm Management Device Therapy and Their Financial Implication: A Prospective Single-Center TwoYear Survey. Hellenic J Cardiol 2016; 57:33-8. [PMID: 26856199 DOI: 10.1016/s1109-9666(16)30016-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cardiac rhythm management devices (CRMDs) have proven their clinical effectiveness for patients with heart rhythm disorders. Little is known about safety and complication rates during the implantation of these devices. This study demonstrated the complication rates related to CRMD implantation, and estimated the additional hospital stay and cost associated with the management of complications. METHODS During a period of one year, a total of 464 consecutive recipients underwent CRMD implantation and were followed for 2 years. Finally, data were analyzed for 398 patients who completed the two-year follow up, resulting in a total of 796 patient-years. RESULTS Of the 201 patients with initial pacemaker (PM) implantations, 6 (2.99%) had seven complications (5 patients had lead dislodgement, 1 of them twice), and 1 patient developed pocket infection. Of the 117 PM replacements, 1 (0.85%) patient developed a complication (pocket erosion). Two patients with complications (1 with an initial PM and 1 with a replacement) died before completing the follow up for reasons unrelated to cardiac causes. There were no complications in either initial implantations (69 patients) or replacements (11 patients) of implantable cardioverter-defibrillators. The average prolongation of the hospital stay was 7 days, ranging from 1 to 35 days, resulting in 17,411 of total additional direct hospital costs. CONCLUSION This study found relatively low rates of complications in patients undergoing CRMD implantation, initial or replacement, in our center, compared with other studies. The additional hospitalization days and costs attributable to these complications depend on the nature of the complication.
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Affiliation(s)
- John Fanourgiakis
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
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Permanent dual chamber epicardial pacemaker implantation in two dogs with complete atrioventricular block. J Vet Cardiol 2015; 17:154-60. [PMID: 25595612 DOI: 10.1016/j.jvc.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/22/2014] [Accepted: 11/12/2014] [Indexed: 11/23/2022]
Abstract
Between November 2013 and December 2013, two dogs with complete atrioventricular (AV) block had a permanent, dual chamber epicardial pacing system implanted. Steroid-eluting unipolar, button-type epicardial leads(a) were sutured to the right atrial appendage and right ventricular wall via a right thoracotomy in both dogs. The pacemakers were programmed in VDD mode. Permanent dual chamber epicardial pacemaker implantation was successful in both dogs with no intra-operative complications. One dog had an acute onset of neurologic signs two days post-operatively that resolved within 24 h. Both dogs have had complete resolution of the clinical signs related to the bradyarrhythmia, and one dog has had complete resolution of chylothorax. One dog had a major lead complication characterized by intermittent loss of capture that resolved by increasing the pacemaker output. Based on the outcome of these two cases, implantation of permanent dual chamber epicardial pacing systems is possible in dogs providing an alternative to dual chamber transvenous systems.
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Cao Y, Zhang Y, Su Y, Bai J, Wang W, Ge J. Assessment of adaptive rate response provided by accelerometer, minute ventilation and dual sensor compared with normal sinus rhythm during exercise: a self-controlled study in chronotropically competent subjects. Chin Med J (Engl) 2015; 128:25-31. [PMID: 25563309 PMCID: PMC4837815 DOI: 10.4103/0366-6999.147798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Dual sensor (DS) for rate adaption was supposed to be more physiological. To evaluate its superiority, the DS (accelerometer [ACC] and minute ventilation [MV]) and normal sinus rate response were compared in a self-controlled way during exercise treadmill testing. Methods: This self-controlled study was performed in atrioventricular block patients with normal sinus function who met the indications of pacemaker implant. Twenty-one patients came to the 1-month follow-up visit. Patients performed a treadmill test 1-month post implant while programmed in DDDR and sensor passive mode. For these patients, sensor response factors were left at default settings (ACC = 8, MV = 3) and sensor indicated rates (SIRs) for DS, ACC and MV sensor were retrieved from the pacemaker memories, along with measured sinus node (SN) rates from the beginning to 1-minute after the end of the treadmill test, and compared among study groups. Repeated measures analysis of variance and profile analysis, as well as variance analysis of randomized block designs, were used for statistical analysis. Results: Fifteen patients (15/21) were determined to be chronotropically competent. The mean differences between DS SIRs and intrinsic sinus rates during treadmill testing were smaller than those for ACC and MV sensor (mean difference between SIR and SN rate: ACC vs. SN, MV vs. SN, DS vs. SN, respectively, 34.84, 17.60, 16.15 beats/min), though no sensors could mimic sinus rates under the default settings for sensor response factor (ACC vs. SN P-adjusted < 0.001; MV vs. SN P-adjusted = 0.002; DS vs. SN P-adjusted = 0.005). However, both in the range of 1st minute and first 3 minutes of exercise, only the DS SIR profile did not differ from sinus rates (P-adjusted = 0.09, 0.90, respectively). Conclusions: The DS under default settings provides more physiological rate response during physical activity than the corresponding single sensors (ACC or MV sensor). Further study is needed to determine if individual optimization would further improve adaptive performance of the DS.
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Affiliation(s)
| | | | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
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Evaluation of left ventricular longitudinal function and synchrony after dual chamber pacemaker implantation. MEDICINA-LITHUANIA 2014; 50:340-4. [PMID: 25541267 DOI: 10.1016/j.medici.2014.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate left ventricular (LV) longitudinal function and dyssynchrony mechanisms after dual chamber pacemaker implantation. MATERIALS AND METHODS The speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and for dyssynchrony evaluation before pacemaker implantation and after 3-month follow-up. The study group consisted of 98 patients with conventional indications for dual chamber pacemaker implantation. RESULTS Speckle tracking echocardiographic methods and image postprocessing revealed impairment of global longitudinal strain and significant LV dyssynchrony derived from 12 basal and mid-septum segments usually untraceable with conventional echocardiographic methods. Despite good physical performance and ejection fraction, global longitudinal strain significantly decreased in all patients from -15.08±0.46 to -13.56±0.5 (P<0.05) as well as mitral annulus movement decreased from 11.57±2.41 to 8.46±1.74cm/s (P<0.001) and from 12.55±2.75 to 10.78±2.82mm (P<0.001). It was expected that patients with dual chamber pacemaker will develop inter- and intraventricular dyssynchrony, but our study showed that pacing lead position did not prevent from LV dysynchronisation and only changed the mechanism. CONCLUSIONS Global longitudinal strain and LV dyssynchrony assessment enables us to detect early signs of LV dysfunction. Mechanisms of dyssynchrony development will be useful for pacemaker programing choices in order to prevent further dyssynchronisation.
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Falase B, Sanusi M, Johnson A, Akinrinlola F, Ajayi R, Oke D. Analysis of a five year experience of permanent pacemaker implantation at a Nigerian Teaching Hospital: need for a national database. Pan Afr Med J 2013; 16:16. [PMID: 24498465 PMCID: PMC3909697 DOI: 10.11604/pamj.2013.16.16.2644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/06/2013] [Indexed: 01/27/2023] Open
Abstract
Introduction Permanent pacemaker implantation is available in Nigeria. There is however no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution and the results are analyzed in this study. Methods The study period was between January 2008 and December 2012. Patient data was extracted from a prospectively maintained database which was designed to include the fields of the European pacemaker patient identification code. Results Of the 51 pacemaker implants done, there were 29 males (56.9%) and 22 females (43.1%). Mean age was 68.2±12.7 years. Clinical indications were syncopal attacks in 25 patients (49%), dizzy spells in 15 patients (29.4%), bradycardia with no symptoms in 10 patients (17.7%) and dyspnoea in 2 patients (3.9%). The ECG diagnosis was complete heart block in 27 patients (53%), second degree heart block in 19 patients (37.2%) and sick sinus syndrome with bradycardia in 5 patients (9.8%). Pacemaker modes used were ventricular pacing in 29 patients (56.9%) and dual chamber pacing in 22 patients (43.1%). Files have been closed in 20 patients (39.2%) and 31 patients (60.8%) are still being followed up with median follow up of 26 months, median of 5 visits and 282 pacemaker checks done. Complications seen during follow up were 3 lead displacements (5.9%), 3 pacemaker infections (5.9%), 2 pacemaker pocket erosions (3.9%), and 1 pacemaker related death (2%). There were 5 non-pacemaker related deaths (9.8%). Conclusion Pacemaker data has been maintained for 5 years. We urge other implanting institutions in Nigeria to maintain similar databases and work towards establishment of a national pacemaker registry.
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Affiliation(s)
- Bode Falase
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Michael Sanusi
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | | | - Fola Akinrinlola
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Reina Ajayi
- Cardiology Unit, Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - David Oke
- Cardiology Unit, Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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El-Damanhoury H, Diab O. Intolerance to physiologic pacing following upgrade of long term ventricular pacing: A drawback of routine upgrade. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Panicker GK, Desai B, Lokhandwala Y. Choosing pacemakers appropriately. HEART ASIA 2009; 1:26-30. [PMID: 27325922 DOI: 10.1136/ha.2008.000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 11/04/2022]
Abstract
The range of implantable cardiac pacing devices has expanded, with the advances in available technology. Indications for cardiac pacing devices, that is pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy devices (CRTs), have expanded for the treatment, diagnosis and monitoring of bradycardia, tachycardia and heart failure. While the need for pacemakers is increasing, not all patients who require pacemakers are receiving them, especially in the Asia-Pacific region. There is a need to be more critical in advising the use of more expensive devices like ICDs and CRT/CRT-D devices, since most patients in the Asia-Pacific region pay out of pocket for these therapies. The AHA-ACC guidelines need not be blindly followed, since they are too wide-sweeping and are often based on the intention-to-treat basis of trials rather than on the parameters of the patients actually enrolled.
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Affiliation(s)
| | - B Desai
- Quintiles ECG Services, Mumbai, India
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32
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Lamas GA, Knight JD, Sweeney MO, Mianulli M, Jorapur V, Khalighi K, Cook JR, Silverman R, Rosenthal L, Clapp-Channing N, Lee KL, Mark DB. Impact of rate-modulated pacing on quality of life and exercise capacity—Evidence from the Advanced Elements of Pacing Randomized Controlled Trial (ADEPT). Heart Rhythm 2007; 4:1125-32. [PMID: 17765608 DOI: 10.1016/j.hrthm.2007.05.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 05/20/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ninety-nine percent of pacemakers implanted in the United States include an option for rate modulation. OBJECTIVE The purpose of this study was to determine whether dual-chamber rate-modulated pacing, when compared with dual-chamber pacing alone, improved quality of life. METHODS This was a single-blind randomized controlled trial comparing dual-chamber with rate-modulated dual-chamber pacing. Patients were enrolled between January 12, 2000, and January 10, 2002, with 1-year follow-up ending December 19, 2002. The study was a U.S. multicenter trial, with 95 sites participating. All patients received a rate modulation-capable dual-chamber pacemaker for standard indications. Patients were screened with an exercise test (Chronotropic Assessment Exercise Protocol) 1 month later. One thousand two hundred seventy-three patients were enrolled; 401 proved ineligible, and 872 (68%) made up the randomized patient cohort. Randomized patients had a mean age of 71 years, 64% were men, and 64% had sinus node dysfunction. Randomization was in a factorial design to (1) dual-chamber rate-modulated pacing versus dual-chamber pacing and (2) automatic mode switching versus no automatic mode switching. The present report is limited to the comparison of rate modulation with no rate modulation (DDDR vs. DDD). The primary endpoint was the score on the Specific Activity Scale, an activity-based cardiovascular disease-specific instrument at 1 year. Secondary endpoints included 6-month treadmill time and additional cardiovascular disease-specific, and generic health-related quality-of-life instruments at 1 year. RESULTS At 6 months, patients with rate modulation had a higher peak exercise heart rate (rate modulation 113.3 +/- 19.6, no rate modulation 101.1 +/- 21.1; P <.0001). Total exercise time was not different between groups. At 1 year, there were no significant differences between groups with respect to Specific Activity Scale or the secondary quality-of-life endpoints. CONCLUSIONS We conclude that rate modulation is ineffective in improving the functional status or quality of life of patients with a bradycardia indication for dual-chamber pacing.
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Affiliation(s)
- Gervasio A Lamas
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
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Silberbauer J, Sulke N. The role of pacing in rhythm control and management of atrial fibrillation. J Interv Card Electrophysiol 2007; 18:159-86. [PMID: 17473977 DOI: 10.1007/s10840-007-9087-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 02/01/2007] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia and is increasing in prevalence with an ageing population. As the arrhythmia is often asymptomatic the true prevalence is likely even higher. Largely because of stroke this arrhythmia places a huge financial burden on the health economy. Despite this, large studies assessing rate versus rhythm control have been equivocal. Because of the ineffectiveness of pharmacological therapy much research effort has been undertaken in device and ablative approaches to rhythm management. Although catheter ablation has gained favour because of the high success rates the technique requires considerable expertise and still has a significant complication profile maintaining interest in pacing therapies for atrial fibrillation. Dual chamber versus single-chamber ventricular pacing has been shown to significantly reduce the incidence of atrial fibrillation. Research is currently underway to see if minimising the deleterious effects of right ventricular apical pacing could further increase the benefits of atrioventricular synchronous pacing. Several studies show some (albeit variable) reduction in AF burden with anti-AF algorithms in the setting of bradycardia. Antitachycardia pacing, on the other hand, has not been shown to treat AF in a randomised trial despite the successful termination of co-existent atrial tachycardias. There is increasing evidence that alternative atrial pacing sites may treat AF by improving atrial function. Furthermore, these strategies coupled with other therapies in a 'hybrid approach' have also showed promising results.
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Affiliation(s)
- John Silberbauer
- Eastbourne General Hospital East Sussex Hospitals NHS Trust, Eastbourne, BN21 2UD, UK
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Martinez C, Tzur A, Hrachian H, Zebede J, Lamas GA. Pacemakers and Defibrillators: Recent and Ongoing Studies That Impact the Elderly. ACTA ACUST UNITED AC 2007; 15:82-7. [PMID: 16525220 DOI: 10.1111/j.1076-7460.2006.04883.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since the first implantation of a cardiac pacemaker in the second half of the 20th century, there have been evolutionary and revolutionary advances in the technology developed for patients with heart rhythm disturbances. These advances, however, have instead failed to demonstrate that mimicry of physiology by a pacing system would deliver a longer and better life to its recipient. Indeed, we are just now in the process of developing a new paradigm in pacing that may finally deliver physiology to the hyperbolically named "physiologic pacing." This article will discuss the reasons for the discrepancy between the earlier studies and the more recent ones, as well as a review of implantable cardioverter-defibrillator trials, keeping in focus the special needs of aged heart rhythm device recipients.
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Affiliation(s)
- Claudia Martinez
- Cardiology Research, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
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35
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Dixit S, Marchlinski FE. Cardiac Pacemakers. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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36
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Sweesy MW, Wilkoff BL, Smith KW, Holland JL. Group Purchasing Organizations: Optimizing Cardiac Device Selection, Therapy Delivery, and Fiscal Responsibility. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1404-9. [PMID: 17201849 DOI: 10.1111/j.1540-8159.2006.00554.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Group purchasing organizations (GPOs) have played a major role in supporting health care delivery in recent years as the healthcare industry has faced stronger economic pressures. Consequently, a position statement was drafted to act as a guideline for a GPO in creating a fiscally responsible, yet unrestricted environment for physicians to select the most appropriate cardiac device for their patients. This cardiac device selection guideline is to be implemented in hundreds of member hospitals but may be of use in non-member hospitals as well. The guideline will only be effective when the physicians or cardiac device caregivers have the knowledge and skills to optimally program and match device therapies and algorithms to individual patient needs.
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Affiliation(s)
- Mark W Sweesy
- Arrhythmia Technologies Institute, Greenville, South Carolina, USA.
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Affiliation(s)
- Hung-Fat Tse
- From the Cardiology Division, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chu-Pak Lau
- From the Cardiology Division, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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38
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Abstract
Permanent cardiac pacing is a widely recognized therapy used for the treatment of several types of bradycardia, atrioventricular (AV) block and sinoatrial node disease mainly. In the beginning, implantable cardiac pacemakers stimulated just one cardiac chamber and right ventricule pacing were the most frequently used devices. In the 1980s, pacemaker's technology focus on restoring AV synchrony, named <<physiologic>> cardiac pacing, allowing the development of dual-chamber pacemakers (DDD, DDDR). Even though theoretical advantages of dual-chamber devices, its implantation is more complicated and expensive. For these reasons, the selection of the optimum mode of pacing is still controversial. Nowadays, available results from many trials that analyze clinical and physiological benefits of the different pacing modes, allow us to conclude that physiologic pacemakers reduce the risk of atrial fibrillation but do not improve survival and do not reduce the risk of stroke. By other hand, the reduction of pacemaker syndrome is not a constant finding in all the trials. In our clinical practice, when we have to select the pacing mode we have to take in account these results together with other factors as patient's characteristics (age, comorbility and life expectansy). Also, data from cost-effectiveness analysis should be added to the available information for the making decision.
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Affiliation(s)
- A Ochagavía Calvo
- Centre de Crítics, Hospital de Sabadell, Corporació Parc Taulí-Institut Universitari, Universidad Autónoma de Barcelona, España.
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Salinas J, Pérez-Castellano N, Isa R, Villacastín J. Cardioinhibition secondary to ventricular pacing. J Cardiovasc Electrophysiol 2006; 17:325-7. [PMID: 16643410 DOI: 10.1111/j.1540-8167.2005.00340.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jorge Salinas
- Unit of Arrhythmias, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
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Körber T, Voss W, Ismer B, Weber F, Nienaber CA, von Knorre GH. [Feasibility and safety of long-term AAI(R) pacing in isolated sinus node syndrome]. Herzschrittmacherther Elektrophysiol 2006; 17:19-25. [PMID: 16547656 DOI: 10.1007/s00399-006-0503-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 01/09/2006] [Indexed: 05/07/2023]
Abstract
Recent investigations prove that AAI(R) pacing is the "ideal" stimulation mode in isolated sick sinus syndrome. Nevertheless, in Germany this bradycardia is treated by AAI(R) pacemakers in less than 4% of cases compared to 25% in other countries. In our institution treatment of patients with isolated sick sinus syndrome is uniform and corresponds to the actual guidelines since the early 1990s; therefore the aim of our study was to analyze feasibility and safety of AAI(R) pacing in a retrospective study. Between 1998 and 2000, 52 of 165 patients (31.5%) with isolated sick sinus syndrome were treated by an AAI(R) pacemaker. The median follow-up duration was 51.5 months (minimal: 36 months). 6 patients died, in all cases unrelated to the stimulation mode. Three patients required reoperations, however, in only one case due to second degree AV block with the need for upgrading to DDD stimulation. Thus, the yearly incidence of this specific complication in the AAI(R) cohort is 0.64%.In conclusion, permanent atrial stimulation in isolated sick sinus syndrome is feasible in a quarter of all cases. It is safe if performed corresponding to actual guidelines. Additionally, single lead AAI(R) pacing is a cost-effective therapy and the only stimulation mode which, today, reliably prevents unnecessary right ventricular stimulation. If, on the other hand, algorithms providing automatic mode switching from AAI to DDD and vice versa are implemented reliably into all dual chamber pacemakers, single chamber atrial pacing will no longer be a subject for discussion.
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Affiliation(s)
- T Körber
- Abteilung für Kardiologie, Klinik für Innere Medizin der Universität, Postfach 100888, 18055 Rostock.
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41
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Melzer C, Sowelam S, Sheldon TJ, Bondke HJ, Baumann G, Combs B, Theres H. Reduction of right ventricular pacing in patients with sinus node dysfunction using an enhanced search AV algorithm. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 28:521-7. [PMID: 15955184 DOI: 10.1111/j.1540-8159.2005.09470.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dual chamber pacing typically results in a high percentage of ventricular pacing. A number of studies have been conducted suggesting detrimental effects of ventricular desynchronization produced by long-term RV pacing. Pacemaker algorithms that extend the AV interval to uncover intrinsic AV conduction have been utilized to reduce ventricular pacing. These algorithms are often limited to AV intervals below 250 ms limiting the ventricular pacing reduction. We hypothesized that by allowing AV intervals to extend beyond 300 ms, a marked reduction in RV pacing can be achieved. METHODS A total of 30 patients (17 men, mean age 71 +/- 9) with standard Brady indications, and implanted with a Medtronic Kappa 700 pacemaker, were randomized to 2-week treatments with default Search AV (KSAV) parameters or Enhanced Search AV (ESAV) parameters. The Enhanced Search AV algorithm included the capability for continuous adjustment of AV delays and the ability to auto disable in patients with persistent AV block. RESULTS Among patients with intact AV conduction, percent VP was greater in KSAV versus ESAV (70 +/- 40% vs 19 +/- 28%, P < 0.001). In patients with persistent AV block, the algorithm suspended appropriately and there was no significant change in the percent VP between both arms of the study. In 18/22 patients, percent VP was reduced below 40%. CONCLUSIONS Substantial reduction in ventricular pacing can be achieved by allowing the AV interval parameters to extend beyond 300 ms using the ESAV algorithm. In patients with AV block, ESAV suspended and patients were paced at their nominal settings.
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Affiliation(s)
- Christoph Melzer
- Humboldt-Universität, Charité Hospital, Schumannstrasse 20/21, 10117 Berlin, Germany
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42
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Bogert LWJ, Erol-Yilmaz A, Tukkie R, Van Lieshout JJ. Varying the heart rate response to dynamic exercise in pacemaker-dependent subjects: effects on cardiac output and cerebral blood velocity. Clin Sci (Lond) 2006; 109:493-501. [PMID: 16038616 DOI: 10.1042/cs20050094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral blood flow increases upon the transition from rest to moderate exercise, but becomes affected when the ability to raise CO (cardiac output) is limited. HR (heart rate) is considered to contribute significantly to the increase in CO in the early stages of dynamic exercise. The aim of the present study was to test whether manipulation of the HR response in patients dependent on permanent rate-responsive ventricular pacing contributes to the increase in CO, MCA V(mean) [mean MCA (middle cerebral artery) velocity] and work capacity during exercise. The effect of setting the pacemaker to DSS ('default' sensor setting) compared with OSS ('optimized' sensor setting) on blood pressure, CO, SV (stroke volume) and MCA V(mean) was evaluated during ergometry cycling. From rest to exercise at 75 W, the rise in HR in OSS [from 73 (65-87) to 116 (73-152) beats/min; P<0.05] compared with DSS [70 (60-76) to 97 (67-117) beats/min; P<0.05] was larger. There was an increase in SV during exercise with DSS, but not with OSS, such that, at all workloads, SVs were greater during DSS than OSS. The slope of the HR-CO relationship was larger with DSS than OSS (P<0.05). From rest to exercise, MCA V(sys) (systolic MCA velocity) increased in OSS and DSS, and MCA V(dias) (diastolic MCA velocity) was reduced with DSS. No changes were observed in MCA V(mean). Manipulation of the pacemaker setting had no effect on the maximal workload [133 (100-225) W in OSS compared with 129 (75-200) W in DSS]. The results indicate that, in pacemaker-dependent subjects with complete heart block and preserved myocardial function, enhancing the HR response to exercise neither augments CO by a proportional offset of the exercise-induced increase in SV nor improves cerebral perfusion.
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Affiliation(s)
- Lysander W J Bogert
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, 1100 DE Amsterdam, The Netherlands
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Abstract
There are currently more than 3 million patients worldwide with implanted pacemakers, and indications for implants are expanding. Pacemakers today are smaller (23-30 g) and fashioned in a more physiologic shape so as to be less obtrusive. They are replete with sophisticated diagnostic and programming features that make troubleshooting of complicated arrhythmias easier. Advanced nurse clinicians need to have a basic understanding of pacemaker function, indications for implantation, an awareness of potential complications, and facility with basic troubleshooting. The purpose of this article is to describe the features of the pacemakers available today and approaches to troubleshooting these devices.
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Affiliation(s)
- Jennifer Woodruff
- Electrophysiology, University of Virginia Health System, Charlottesville, VA, USA
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Ferro A, Duilio C, Santomauro M, Salvatore M, Cuocolo A. Haemodynamic effects of dual-chamber pacing versus ventricular pacing during a walk test in patients with depressed or normal left ventricular function. Eur J Nucl Med Mol Imaging 2005; 32:1075-80. [PMID: 15891919 DOI: 10.1007/s00259-005-1790-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 02/04/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Dual-chamber rate-modulated pacing provides haemodynamic benefits compared with ventricular pacing at rest, but it is unclear whether this also holds true during physical exercise in patients with heart failure. This study assessed the haemodynamic response to a walk test during dual-chamber pacing and ventricular pacing in patients with depressed or normal left ventricular (LV) function. METHODS Twelve patients with an LV ejection fraction <50% and 11 patients with an LV ejection fraction >or=50% underwent two randomised 6-min walk tests under dual-chamber rate-modulated pacing and ventricular pacing at a fixed rate of 70 beats/min. All patients had a dual-chamber pacemaker implanted for complete heart block. LV function was monitored by a radionuclide ambulatory system. RESULTS In patients with depressed LV function, the change from dual-chamber pacing to ventricular pacing induced a decrease in end-systolic volume at the peak of the walk test (P<0.05), with no difference in end-diastolic volume. As a consequence, higher increases in LV ejection fraction (P<0.0001) and stroke volume (P<0.01) were observed during ventricular pacing. No difference in cardiac output was found between the two pacing modes. In patients with normal LV function, the change from dual-chamber pacing to ventricular pacing induced a significant decrease in cardiac output (P<0.005 at rest and P<0.05 at the peak of the walk test). CONCLUSION Compared with dual-chamber rate-modulated pacing, ventricular pacing improves cardiac function and does not affect cardiac output during physical activity in patients with depressed LV function, whereas it impairs cardiac output in those with normal function.
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Affiliation(s)
- Adele Ferro
- Department of Biomorphological and Functional Sciences, Institute of Biostructure and Bioimages of the National Council of Research, University Federico II, Naples, Italy
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Galtes I, Lamas GA. Cardiac pacing for bradycardia support: Evidence-based approach to pacemaker selection and programming. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:385-395. [PMID: 15324614 DOI: 10.1007/s11936-004-0022-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The vast majority of pacemakers implanted in the United States for the treatment of symptomatic bradycardia are dual-chamber systems with a complex array of functions, such as rate responsiveness, dynamic atrioventricular delay, and automatic mode switching. Basic hemodynamic studies have convincingly demonstrated the superiority of maintaining atrioventricular synchrony. However, clinical trials have failed to demonstrate the impressive results expected based on physiologic data. The most recent randomized clinical trials have demonstrated that dual-chamber devices, when compared with single-chamber ventricular pacing, do not prevent mortality or stroke, and lead to an unexpectedly small reduction in heart failure hospitalizations. Although improvements in quality of life have not been consistently found when comparing ventricular-based versus atrial-based pacing, a reduction in the incidence of newly diagnosed atrial fibrillation in dual chamber-paced patients has been reported by most trials. Dual-chamber pacing has been reported to reduce pacemaker syndrome in US trials. The addition of rate modulation, in spite of attempting to replicate the normal response to exercise, has not shown a consistently positive impact on quality of life or treadmill time. The use of pacemakers for the treatment of vasovagal syncope is controversial. Adding dual-chamber sensing ability to current implanted defibrillators considerably reduces the number of inappropriate shocks but may increase mortality if not programmed to minimize ventricular stimulation.
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Affiliation(s)
- Israel Galtes
- Mount Sinai Medical Center, Butler Building, 4300 Alton Road, Miami Beach, FL 33140, USA.
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Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol 2004; 44:671-719. [PMID: 15358045 DOI: 10.1016/j.jacc.2004.07.002] [Citation(s) in RCA: 833] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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47
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Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary. Circulation 2004; 110:588-636. [PMID: 15289388 DOI: 10.1161/01.cir.0000134791.68010.fa] [Citation(s) in RCA: 1202] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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