1
|
Matsuda Y, Masuda M, Asai M, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Hata Y, Uematsu H, Higashino N, Nakao S, Kusuda M, Mano T. Impact of Immunosuppressive Therapy on Lead Dislodgement After Cardiac Implantable Electronic Device Implantation. Clin Cardiol 2024; 47:e24310. [PMID: 38888132 PMCID: PMC11184469 DOI: 10.1002/clc.24310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUNDS Lead dislodgement is a severe complication in cardiac implantable electronic device (CIED) implantation. Inflammation after CIED implantation results in the development of adhesions between lead and tissues, resulting in the lead becoming fixed in the body. In patients with immunosuppressive therapy, however, adhesion is inhibited by anti-inflammatory effects. However, the association between lead dislodgement and immunosuppressive therapy has not been clarified. The purpose of this study was to investigate the association between lead dislodgement and immunosuppressive therapy. HYPOTHESIS We hypothesized that lead dislodgement more frequently occur in patients with immunosuppressive therapy than those without. METHODS In total, 651 consecutive patients who underwent CIED implantation or lead addition (age, 76 ± 11 years; and males, 374 [58%], high voltage device, 121 [19%], lead addition 23 [4%]) were retrospectively enrolled. Immunosuppressive therapy was with regular steroids or immunosuppressants. Lead placement was guided by fluoroscopy, and active fixation leads were used. Restraint of the upper limb by chest tape was performed for 1 week after the procedure. Lead dislodgement was defined as a change in lead position and/or lead failure requiring reoperation. RESULTS Twenty (3.1%) patients received immunosuppressive therapy. Among these, 15 (2.3%) patients regularly took steroids and 8 (1.2%) took immunosuppressants. Lead dislodgement occurred in 10 (1.5%) patients. Lead dislodgement was more frequent in patients with immunosuppressive therapy than in those without (3 [15%] vs. 7 [1%], p = 0.003). CONCLUSION In patients with CIED implantation or lead addition, lead dislodgement is more frequent in patients with immunosuppressive therapy than in those without.
Collapse
Affiliation(s)
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | | | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | | | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | | | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | - Sho Nakao
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | - Masaya Kusuda
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular CenterAmagasakiHyogoJapan
| |
Collapse
|
2
|
Dhindsa DS, Mekary W, El-Chami MF. Pacing and Defibrillation Consideration in the Era of Transcatheter Tricuspid Valve Replacement. Curr Cardiol Rep 2024; 26:331-338. [PMID: 38492178 DOI: 10.1007/s11886-024-02032-7] [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] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE OF REVIEW Tricuspid regurgitation is a commonly encountered valvular pathology in patients with trans-tricuspid pacing or implantable cardioverter-defibrillator leads. Transcatheter tricuspid valve interventions are increasingly performed in patients at high surgical risk. Implantation of these valves can lead to the "jailing" of a trans-tricuspid lead. This practice carries both short- and long-term risks of lead failure and subsequent infection without the ability to perform traditional transvenous lead extraction. Herein, this manuscript reviews available therapeutic options for lead management in patients undergoing transcatheter tricuspid valve interventions. RECENT FINDINGS The decision to jail a lead may be appropriate in certain high-risk cases, though extraction may be a better option in most cases given the variety of options for re-implant, including leadless pacemakers, valve-sparing systems, epicardial leads, leads placed directly through prosthetic valves, and the completely subcutaneous implantable-defibrillator. A growing number of patients meet the requirement for CIED implantation in the United States. A significant proportion of these patients will have tricuspid valve dysfunction, either related to or independent of their transvenous lead. As with any percutaneous intervention that has shown efficacy, the role of TTVI is also likely to increase as this therapy advances beyond the investigational phase. As such, the role of the heart team in the management of these patients will be increasingly critical in the years to come, and in those patients that have pre-existing CIED leads, we advocate for the involvement of an electrophysiologist in the heart team.
Collapse
Affiliation(s)
- Devinder S Dhindsa
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA
| | - Wissam Mekary
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA.
| |
Collapse
|
3
|
Ponnusamy SS, Ramalingam V, Mariappan S, Ganesan V, Anand V, Syed T, Murugan S, Kumar M, Vijayaraman P. Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study). Heart Rhythm 2024; 21:419-426. [PMID: 38142831 DOI: 10.1016/j.hrthm.2023.12.009] [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: 12/03/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) has been suggested as an alternative modality for biventricular pacing in cardiac resynchronization therapy (CRT)-eligible patients. As it provides stable R-wave sensing, LBBP has been recently used to provide sensing of ventricular arrhythmia in patients receiving implantable cardioverter-defibrillator (ICD) with CRT. OBJECTIVE The aim of this study was to analyze the long-term safety and efficacy of the LBBP lead for appropriate detection of ventricular arrhythmia and delivery of antitachycardia pacing (ATP) in patients requiring defibrillator therapy with CRT. METHODS CRT-eligible patients who underwent successful LBBP-optimized ICD and LBBP-optimized CRT with defibrillator were enrolled. The LBBP lead was connected to the right ventricular-P/S port after capping the IS-1 connector plug of the DF-1-ICD lead. LBBP-optimized ICD or LBBP-optimized CRT with defibrillator was decided on the basis of correction of conduction system disease. Documented arrhythmic episodes and therapy delivered were analyzed. RESULTS Thirty patients were enrolled. The mean age was 59.7 ± 10.5 years. LBBP resulted in an increase in left ventricular ejection fraction from 29.9% ± 4.6% to 43.9% ± 11.2% (P < .0001). During a mean follow-up of 22.9 ± 12.5 months, 254 ventricular arrhythmic events were documented. Appropriate events (n = 225 [89%]) included nonsustained ventricular tachycardia (VT) (n = 212 episodes [94%]), VT (n = 8 [3.5%]), and ventricular fibrillation (n = 5 [2.5%]). ATP efficacy in terminating VT was 75%. Eleven percent of episodes (n = 29) were inappropriately detected because of T-wave oversensing. Inappropriate therapy (ATP) was delivered for 14 episodes (5.5%). Three patients (10%) had worsening of tricuspid regurgitation. CONCLUSION Sensing from the LBBP lead for arrhythmia detection is safe as ∼90% of the episodes were detected appropriately. Future studies with a dedicated LBBP-defibrillator lead along with algorithms to avoid oversensing can help in combining defibrillation with conduction system pacing.
Collapse
Affiliation(s)
- Shunmuga Sundaram Ponnusamy
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Selvaganesh Mariappan
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Vijesh Anand
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Thabish Syed
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Senthil Murugan
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Mahesh Kumar
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania
| |
Collapse
|
4
|
Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
Collapse
Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| |
Collapse
|
5
|
Villegas EG, Juárez Del Río JI, Carmona JCR, Valdíris UR, Peinado ÁA, Peinado RP. Efficacy and safety of the extraction of cardiostimulation leads using a mechanical dissection tool. A single center experience. Pacing Clin Electrophysiol 2023; 46:217-225. [PMID: 36401870 DOI: 10.1111/pace.14625] [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: 07/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The percutaneous extraction of endovascular cardiostimulation and defibrillation leads is the most frequent technique nowadays. The tools used today must guarantee the success of the procedure, with the minimum of complications. Our objective was to analyze the safety and efficacy of lead extraction using the Evolution mechanical dissection tool (Cook Medical, USA). METHODS A retrospective study was carried out in a total of 826 consecutive patients from October 2009 to December 2018 who underwent the procedure with the Evolution mechanical dissection tool. Preoperative study included complete blood tests, echocardiogram, and chest X-ray. The procedures were performed in the operating room, under general anesthesia and echocardiographic control. RESULTS A total of 1227 leads were extracted with a mean chronicity of 10.3 ± 5.1 years. Clinical success (CS) rate was 99.7%. A total of 16 (1.9%) complications occurred, 2 (0.24%) were major complications and 14 (1.7%) were minor complications. There was no operative mortality. There was no statistically significant relationship between implant chamber and complete efficacy. The complete extraction was achieved in all left ventricular leads, in 762 of 774 (98.45%) of right ventricular lead removal, and in 330 of 334 (98.8%) of right atrial leads (p = .31). CONCLUSION In our experience, percutaneous extraction of intravenous leads via the use of the Evolution tool (Cook Medical, USA), is a very effective and safe technique that offers low morbidity and mortality.
Collapse
|
6
|
Miyagi Y, Oomori H, Maeda M, Murata T, Ota K, Motoji Y, Amitani R, Ueda H, Morishima M, Matsuyama T, Kurita J, Maruyama Y, Sasaki T, Sakamoto SI, Ishii Y. Surgical Management of Cardiac Implantable Electronic Device Complications in Patients Unsuitable for Transvenous Lead Extraction. Circ J 2022; 87:103-110. [PMID: 36476494 DOI: 10.1253/circj.cj-22-0456] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although surgical approaches for infected or failing cardiac implantable electronic device (CIED) leads are more invasive than transvenous approaches, they are still required for patients considered unsuitable for transvenous procedures. In this study, surgical management with transvenous equipment for CIED complications was examined in patients unsuitable for transvenous lead extraction.Methods and Results: We retrospectively examined 152 consecutive patients who underwent CIED extraction between April 2009 and December 2021 at the Department of Cardiovascular Surgery, Nippon Medical School. Nine patients (5.9%; mean [±SD] age 61.7±16.7 years) who underwent open heart surgery were identified as unsuitable for the isolated transvenous approach. CIED types included 5 pacemakers and 4 implantable cardioverter-defibrillators; the mean [±SD] lead age was 19.5±7.0 years. Indications for surgical management according to Heart Rhythm Society guidelines included failed prior to transvenous CIED extraction (n=6), intracardiac vegetation (n=2), and severe lead adhesion (n=1). Transvenous CIED extraction tools were used in all patients during or before surgery. Additional surgical procedures with CIED extraction included epicardial lead implantation (n=4) and tricuspid valve repair (n=3). All patients were discharged; during the follow-up period (mean 5.7±3.7 years), only 1 patient died (non-cardiac cause). CONCLUSIONS Surgical procedures and transvenous extraction tools were combined in the removal strategy for efficacious surgical management of CIED leads. Intensive surgical procedures were safely performed in patients unsuitable for transvenous extraction.
Collapse
Affiliation(s)
- Yasuo Miyagi
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Hiroya Oomori
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Motohiro Maeda
- Department of Cardiovascular Surgery, Nippon Medical School
| | | | - Keisuke Ota
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Yusuke Motoji
- Department of Cardiovascular Surgery, Nippon Medical School
| | | | - Hitomi Ueda
- Department of Cardiovascular Surgery, Nippon Medical School
| | | | | | - Jiro Kurita
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Yuji Maruyama
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Takashi Sasaki
- Department of Cardiovascular Surgery, Nippon Medical School
| | | | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School
| |
Collapse
|
7
|
Tan NY, Ladas TP, Christopoulos G, Sugrue AM, van Zyl M, Ladejobi AO, Lodhi FK, Hu TY, Ezzeddine FM, Agboola K, Uecker D, Maor E, Tri JA, Jiang Z, Yasin OZ, DeSimone CV, Killu AM, Asirvatham SJ, Del-Carpio Munoz F. Ventricular nanosecond pulsed electric field delivery using active fixation leads: a proof-of-concept preclinical study. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01268-z. [PMID: 35771400 DOI: 10.1007/s10840-022-01268-z] [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: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Mid-myocardial ventricular arrhythmias are challenging to treat. Cardiac electroporation via pulsed electric fields (PEFs) offers significant promise. We therefore tested PEF delivery using screw-in pacemaker leads as proof-of-concept. METHODS In 5 canine models, we applied nanosecond PEF (pulse width 300 ns) across the right ventricular (RV) septum using a single lead bipolar configuration (n = 2) and between two leads (n = 3). We recorded electrograms (EGMs) prior to, immediately post, and 5 min after PEF. Cardiac magnetic resonance imaging (cMRI) and histopathology were performed at 2 weeks and 1 month. RESULTS Nanosecond PEF induced minimal extracardiac stimulation and frequent ventricular ectopy that terminated post-treatment; no canines died with PEF delivery. With 1 lead, energy delivery ranged from 0.64 to 7.28 J. Transient ST elevations were seen post-PEF. No myocardial delayed enhancement (MDE) was seen on cMRI. No lesions were noted on the RV septum at autopsy. With 2 leads, energy delivery ranged from 56.3 to 144.9 J. Persistent ST elevations and marked EGM amplitude decreases developed post-PEF. MDE was seen along the septum 2 weeks and 1 month post-PEF. There were discrete fibrotic lesions along the septum; pathology revealed dense connective tissue with < 5% residual cardiomyocytes. CONCLUSIONS Ventricular electroporation is feasible and safe with an active fixation device. Reversible changes were seen with lower energy PEF delivery, whereas durable lesions were created at higher energies. Central illustration: pulsed electric field delivery into ventricular myocardium with active fixation leads.
Collapse
Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Thomas P Ladas
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Georgios Christopoulos
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Alan M Sugrue
- Department of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Adetola O Ladejobi
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Fahad K Lodhi
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Tiffany Y Hu
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Kolade Agboola
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | | | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Jason A Tri
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Zhi Jiang
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Omar Z Yasin
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA.
| |
Collapse
|
8
|
Das TS, Wilson D. Optimal entrainment for removal of pinned spiral waves. Phys Rev E 2022; 105:064213. [PMID: 35854563 DOI: 10.1103/physreve.105.064213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Cardiac fibrillation is caused by self-sustaining spiral waves that occur in the myocardium, some of which can be pinned to anatomical obstacles, making them more difficult to eliminate. A small electrical stimulation is often sufficient to unpin these spirals but only if it is applied during the vulnerable unpinning window. Even if these unpinning windows can be inferred from data, when multiple pinned spirals exist, their unpinning windows will not generally overlap. Using phase-based reduction techniques, we formulate and solve an optimal control problem to yield a time-varying external voltage gradient that can synchronize a collection of spiral waves that are pinned to a collection of heterogeneous obstacles. Upon synchronization, the unpinning windows overlap so that they can be simultaneously unpinned by applying an external voltage gradient pulse at an appropriate moment. Numerical validation is presented in bidomain model simulations. Results represent a proof-of-concept illustration of the proposed unpinning strategy which explicitly incorporates heterogeneity in the problem formulation and requires no real-time feedback about the system state.
Collapse
Affiliation(s)
- Tuhin Subhra Das
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - Dan Wilson
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, Tennessee 37996, USA
| |
Collapse
|
9
|
Morita J, Yamaji K, Nagashima M, Kondo Y, Sadohara Y, Hirokami J, Kuji R, Korai K, Fukunaga M, Hiroshima K, Ando K, Goya M. Predictors of lead break during transvenous lead extraction. J Arrhythm 2021; 37:645-652. [PMID: 34141017 PMCID: PMC8207345 DOI: 10.1002/joa3.12524] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown. METHODS We included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy. RESULTS A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07-1.17; P < .001), passive leads (OR 2.29 95% CI 1.09-4.80; P = .028), coradial leads (OR 3.45 95% CI 1.72-6.92; P < .001), and insulators made of nonpolyurethane (OR 2.38 95% CI 1.03-5.26; P = .04) as predictors of lead break. Broken leads needed longer procedure times and were associated with a higher rate of cardiac tamponade. CONCLUSIONS Lead age, coradial bipolar leads, passive leads, and leads without polyurethane insulation were predictors of lead break and could increase the difficulty of lead extraction.
Collapse
Affiliation(s)
- Junji Morita
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Kyohei Yamaji
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | | | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Yohei Sadohara
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Jun Hirokami
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Rei Kuji
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Kengo Korai
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Masato Fukunaga
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | | | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| |
Collapse
|
10
|
Schaller RD, Sadek MM. Intracardiac Echocardiography During Transvenous Lead Extraction. Card Electrophysiol Clin 2021; 13:409-418. [PMID: 33990279 DOI: 10.1016/j.ccep.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transvenous lead extraction is an invaluable procedure within the contemporary management of cardiac implantable electronic devices. Transvenous lead extraction has traditionally been guided by fluoroscopy. Complementary imaging with intracardiac echocardiography can provide valuable additional information, such as identification of complications, lead-adherent echodensities, and sites of lead-tissue adherence. As such, it can be used to aid in risk stratification before lead removal, help to choose tools or techniques, and provide visual monitoring throughout the procedure. Intracardiac echocardiography can be incorporated into the lead extraction workflow of the contemporary electrophysiologist and provide valuable information supporting safety and efficacy.
Collapse
Affiliation(s)
- Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mouhannad M Sadek
- Arrhythmia Service, Division of Cardiology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Clementy N, Bodin A, Bisson A, Teixeira-Gomes AP, Roger S, Angoulvant D, Labas V, Babuty D. The Defibrillation Conundrum: New Insights into the Mechanisms of Shock-Related Myocardial Injury Sustained from a Life-Saving Therapy. Int J Mol Sci 2021; 22:ijms22095003. [PMID: 34066832 PMCID: PMC8125879 DOI: 10.3390/ijms22095003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Implantable cardiac defibrillators (ICDs) are recommended to prevent the risk of sudden cardiac death. However, shocks are associated with an increased mortality with a dose response effect, and a strategy of reducing electrical therapy burden improves the prognosis of implanted patients. We review the mechanisms of defibrillation and its consequences, including cell damage, metabolic remodeling, calcium metabolism anomalies, and inflammatory and pro-fibrotic remodeling. Electrical shocks do save lives, but also promote myocardial stunning, heart failure, and pro-arrhythmic effects as seen in electrical storms. Limiting unnecessary implantations and therapies and proposing new methods of defibrillation in the future are recommended.
Collapse
Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
- Correspondence: ; Tel.: +33-247-474-687; Fax: +33-247-475-919
| | - Alexandre Bodin
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Ana-Paula Teixeira-Gomes
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Sebastien Roger
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Denis Angoulvant
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Valérie Labas
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Dominique Babuty
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| |
Collapse
|
12
|
Qin D, Chokshi M, Sabeh MK, Maan A, Bapat A, Bode WD, Hanley A, Hucker WJ, Ng CY, Funamoto M, Barrett CD, Mela T. Comparison between TightRail rotating dilator sheath and GlideLight laser sheath for transvenous lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:895-902. [PMID: 33675073 DOI: 10.1111/pace.14206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND There are limited data on the comparative analyses of TightRail rotating dilator sheath (Philips) and laser sheath for lead extraction. OBJECTIVE To evaluate the effectiveness and safety of the TightRail sheath as a primary or secondary tool for transvenous lead extraction (TLE). METHODS Retrospective cohort analysis of 202 consecutive patients who underwent TLE using either TightRail sheath and/or GlideLight laser sheath (Philips) in our hospital. The study population was divided into three groups: Group A underwent TLE with laser sheath only (N = 157), Group B with TightRail sheath only (N = 22), and Group C with both sheaths (N = 23). RESULTS During this period, 375 leads in 202 patients were extracted, including 297 leads extracted by laser sheath alone, 45 leads by TightRail sheath alone, and 33 by both TightRail sheath and laser sheaths. The most common indications included device infection (44.6%) and lead-related complications (44.1%). The median age of leads was 8.9 years. TightRail sheath (Group B) achieved similar efficacy as a primary extraction tool compared with laser sheath (Group A), with complete procedure success rate of 93.3% (vs. 96.6%, P = .263) and clinical success rate of 100.0% (vs. 98.1%, P = .513). Among 32 leads in which Tightrail was used after laser had failed (Group C), the complete procedure success rate was 75.8%. No significant difference in procedural adverse events was observed. CONCLUSION Our single-center experience confirms that the TightRail system is an effective first-line and second-line method for TLE. Further investigation is required to guide the selection of mechanical and laser sheaths in lead extraction cases.
Collapse
Affiliation(s)
- Dingxin Qin
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moulin Chokshi
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohamad Khaled Sabeh
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abhishek Maan
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aneesh Bapat
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Weeranun D Bode
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alan Hanley
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William J Hucker
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chee Yuan Ng
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Masaki Funamoto
- Cardiac Surgery Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Conor D Barrett
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theofanie Mela
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Keiler J, Schulze M, Dreger R, Springer A, Öner A, Wree A. Quantitative and Qualitative Assessment of Adhesive Thrombo-Fibrotic Lead Encapsulations (TFLE) of Pacemaker and ICD Leads in Arrhythmia Patients-A Post Mortem Study. Front Cardiovasc Med 2020; 7:602179. [PMID: 33330664 PMCID: PMC7734031 DOI: 10.3389/fcvm.2020.602179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
The demand for cardiac implantable electronic devices for arrhythmia therapy is still unabated and rising. Despite onward optimizations, lead-related problems such as infections or fractures often necessitate lead extraction. Due to adhesive thrombo-fibrotic lead encapsulations (TFLE) transvenous lead extraction is challenging and risky. However, knowledge on TFLEs and possible correlations with technical lead parameters and dwelling time (DT) were hitherto insufficiently studied. Therefore, we analyzed TFLEs of 62 lead from 35 body donor corpses to gain information for a potential lead design optimization. We examined both TFLE topography on the basis on anatomical landmarks and histo-morphological TFLE characteristics by means of histological paraffin sections and scanning electron microscopy of decellularized samples. The macroscopic analysis revealed that all leads were affected by TFLEs, mainly in the lead bearing veins. Half (47.2%) of the right-ventricular leads possessed adhesions to the tricuspid valve. On average, 49.9 ± 21.8% of the intravascular lead length was covered by TFLE of which 82.8 ± 16.2% were adhesive wall bindings (WB). The discrete TFLEs with at least one WB portion had a mean length of 95.0 ± 64.3 mm and a maximum of 200 mm. Neither sex, DT nor certain technical lead parameters showed distinct tendencies to promote or prevent TFLE. TFLE formation seems to start early in the first 1-2 weeks after implantation. The degree of fibrotization of the TFLE, starting with a thrombus, was reflected by the amount of compacted collagenous fibers and likewise largely independent from DT. TFLE thickness often reached several hundred micrometers. Calcifications were occasionally seen and appeared irregularly along the TFLE sheath. Leadless pacemaker systems have the advantage to overcome the problem with TFLEs but hold their own specific risks and limitations which are not fully known yet.
Collapse
Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Ronja Dreger
- Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Armin Springer
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
| | - Alper Öner
- Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
14
|
Bodin A, Labas V, Bisson A, Teixeira-Gomes AP, Blasco H, Tomas D, Combes-Soia L, Marcelo P, Miquelestorena-Standley E, Baron C, Angoulvant D, Babuty D, Clementy N. Acute pathophysiological myocardial changes following intra-cardiac electrical shocks using a proteomic approach in a sheep model. Sci Rep 2020; 10:20252. [PMID: 33219330 PMCID: PMC7679418 DOI: 10.1038/s41598-020-77346-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICD) are meant to fight life-threatening ventricular arrhythmias and reduce overall mortality. Ironically, life-saving shocks themselves have been shown to be independently associated with an increased mortality. We sought to identify myocardial changes at the protein level immediately after ICD electrical shocks using a proteomic approach. ICD were surgically implanted in 10 individuals of a healthy male sheep model: a control group (N = 5) without any shock delivery and a shock group (N = 5) with the delivery of 5 consecutive shocks at 41 J. Myocardial tissue samples were collected at the right-ventricle apex near to the lead coil and at the right ventricle basal free wall region. Global quantitative proteomics experiments on myocardial tissue samples were performed using mass spectrometry techniques. Proteome was significantly modified after electrical shock and several mechanisms were associated: protein, DNA and membrane damages due to extreme physical conditions induced by ICD-shock but also due to regulated cell death; metabolic remodeling; oxidative stress; calcium dysregulation; inflammation and fibrosis. These proteome modifications were seen in myocardium both “near” and “far” from electrical shock region. N-term acetylated troponin C was an interesting tissular biomarker, significantly decreased after electrical shock in the “far” region (AUC: 0.93). Our data support an acute shock-induced myocardial tissue injury which might be involved in acute paradoxical deleterious effects such as heart failure and ventricular arrhythmias.
Collapse
Affiliation(s)
- Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. .,INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.
| | - Valérie Labas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Hélène Blasco
- Imagerie Et Cerveau - UMR 1253, Université de Tours, Tours, France
| | - Daniel Tomas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Lucie Combes-Soia
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Paulo Marcelo
- Plate-Forme ICAP, Centre Universitaire de Recherche en Santé, Université de Picardie Jules Verne, 80054, Amiens, France
| | | | - Christophe Baron
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.,Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.,Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| |
Collapse
|
15
|
Algorithm for the analysis of pre-extraction computed tomographic images to evaluate implanted lead-lead interactions and lead-vascular attachments. Heart Rhythm 2020; 17:1009-1016. [PMID: 31931170 DOI: 10.1016/j.hrthm.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/02/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The number of lead extractions is growing because of the greater population and increasing age of individuals with a cardiac implantable electronic device. Lead extraction procedures can be complex undertakings with risk of significant mortality, and vascular tears in the superior vena cava are of greatest concern. OBJECTIVE The purpose of this study was to study whether a novel algorithm that analyzes pre-extraction computed tomographic (CT) images can determine the likelihood and location of lead-lead interactions and lead-vessel attachment within patients' venous vasculatures. This information can be used to identify potential case challenges in the planning stages. METHODS We developed an algorithm to estimate the presence and position of lead-lead interactions and lead-vessel adherences by tracking distance between the leads and distance between the lead and superior vena cava in a sample of 12 patients referred to the United Heart and Vascular Clinic for lead extractions due to infection (n = 5), lead failure (n = 5), and tricuspid regurgitation (n = 2). RESULTS Preliminary results indicate that the developed algorithm successfully identified lead-lead and lead-vascular attachments compared to review of CT images by medical experts. CONCLUSION With future validation and clinical implementation, this algorithm could aid physician preparedness by minimizing intraprocedural emergencies and may improve patient outcomes.
Collapse
|
16
|
Monkhouse C, Cambridge A, Chow AWC, Behar JM. High-voltage impedance rise; mechanism and management in patients with transvenous implantable cardioverter-defibrillators: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-8. [PMID: 31911989 PMCID: PMC6939807 DOI: 10.1093/ehjcr/ytz220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/17/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022]
Abstract
Background We describe a case series of patients for a gradual rise in daily, low-voltage sub-threshold measurement (LVSM) of shock (high-voltage, HV) impedance in a group of patients with Boston Scientific implantable cardioverter-defibrillators (ICDs) and investigate the cause of the abnormality. Case summary Six patients presented with a gradual rise in HV impedance above normal range (132.5 ± 20.8 Ω). Patients were young with a mean age of 29 ± 11 years, four patients had hypertrophic cardiomyopathy, one left ventricular non-compaction, and one long QT. All lead designs were silicon body with GORE polytetrafluoroethylene (ePTFE) coated coils, and a lower true shock impedance (TSI) was seen in all cases with full output synchronized shock. We compared the rate of HV impedance rise with our historical cohort of Boston ICDs using an unpaired t-test. The change in impedance per month was significantly higher amongst our six patients when compared with our cohort of Boston Scientific ICDs (3.2 ± 1.9 Ω/month vs. 0.0008 ± 0.005 Ω/month, P < 0.001). Patients were individually investigated and management discussed in a dedicated device multi-disciplinary team meeting (MDT). Discussion There are distinct differences between TSI and LVSM. The TSI is derived from a full output shock, whilst LVSM is calculated from a small current output. These cases highlight the inaccuracies of the LVSM measurement. The gradual rise in LVSM is significantly higher than the value for TSI in these patients we propose the most likely mechanism is encapsulation fibrosis surrounding the right ventricular shock coil. Management for these patients requires vigorous testing to rule out electrical failure, and replacement maybe necessary.
Collapse
Affiliation(s)
- Christopher Monkhouse
- Department of Cardiac Electrophysiology, Barts Heart Centre, West Smithfields, London EC1A 7BE, UK
| | - Alex Cambridge
- Department of Cardiac Electrophysiology, Barts Heart Centre, West Smithfields, London EC1A 7BE, UK
| | - Anthony W C Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, West Smithfields, London EC1A 7BE, UK
| | - Jonathan M Behar
- Department of Cardiac Electrophysiology, Barts Heart Centre, West Smithfields, London EC1A 7BE, UK
| |
Collapse
|
17
|
Chrispin J, Love CJ. Computed Tomography Imaging Before Lead Extraction. JACC Clin Electrophysiol 2019; 5:1447-1449. [DOI: 10.1016/j.jacep.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
|
18
|
Resistant Ventricular Arrhythmia and the Role of Overdrive Pacing in the Suppression of the Electrical Storm. Case Rep Cardiol 2019; 2019:6592927. [PMID: 31249712 PMCID: PMC6556359 DOI: 10.1155/2019/6592927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/18/2019] [Indexed: 11/18/2022] Open
Abstract
Ventricular arrhythmia storm is a state of cardiac instability characterized by multiple ventricular arrhythmias or multiple ICD therapies within a 24-hour duration. Management of this life-threatening state depends on the reversal of the cause besides either electrical or medical management of the arrhythmia. We report a case of a 54-year-old male who underwent a percutaneous coronary intervention following massive acute myocardial infarction. Afterwards, he developed frequent life-threatening ventricular arrhythmias that required multiple shocks and antiarrhythmic medications. Despite all these interventions, it was very difficult to control the electrical instability, but after overdrive ventricular pacing, the storm subsided and within a few days the case was stabilized. Overdrive pacing is an easy temporary modality to control the resistant arrhythmia following myocardial infarction.
Collapse
|
19
|
MacIntyre CJ, Sapp JL, Abdelwahab A, Al-Harbi M, Doucette S, Gray C, Gardner MJ, Parkash R. The Effect of Shock Burden on Heart Failure and Mortality. CJC Open 2019; 1:161-167. [PMID: 32159102 PMCID: PMC7063602 DOI: 10.1016/j.cjco.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background Prior studies have demonstrated an association between appropriate implantable cardioverter defibrillator (ICD) shocks and mortality in clinical trials. The effect of shock burden on heart failure and mortality has not been previously studied in a large population-based cohort. Methods The cohort was derived using a comprehensive prospective ICD registry in the province of Nova Scotia with a mean follow-up of 4 ± 2.3 years. With the use of time-varying analysis, the relationship among shock burden, mortality, and heart failure hospitalization was determined. Results A total of 776 patients (mean age of 64.8 years) were included in the study, of whom 37% received appropriate therapy during follow-up. A single ICD shock did not confer an increased mortality risk compared with no therapy (hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.84-1.79; P = 0.3), but mortality risk was significantly increased with ≥ 2 shocks (HR, 3.23; 95% CI, 2.04-5.09; P < 0.0001). There was a significant increase in heart failure hospitalization associated with receiving 1 ICD shock (HR, 2.05; 95% CI, 1.46-2.89; P < 0.0001) or more than 1 ICD shock (HR, 4.36; CI, 2.53-7.52; P < 0.0001) compared with patients receiving no ICD therapy. Patients who received antitachycardia pacing alone showed no difference in heart failure hospitalization (HR, 0.93; CI, 0.67-1.29; P = 0.7) and improved survival (HR, 0.69; CI, 0.5-0.96; P = 0.03) compared with those receiving no ICD therapy. Conclusion Ventricular arrhythmia treated with appropriate ICD shocks is associated with an increased risk of heart failure hospitalization, whereas recurrent episodes of ventricular arrhythmia requiring shocks are associated with both higher mortality and higher heart failure hospitalization rates.
Collapse
Affiliation(s)
- Ciorsti J MacIntyre
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Amir Abdelwahab
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mousa Al-Harbi
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Gray
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Martin J Gardner
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
20
|
Dusi V, De Ferrari GM, Pugliese L, Schwartz PJ. Cardiac Sympathetic Denervation in Channelopathies. Front Cardiovasc Med 2019; 6:27. [PMID: 30972341 PMCID: PMC6443634 DOI: 10.3389/fcvm.2019.00027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/01/2019] [Indexed: 12/24/2022] Open
Abstract
Left cardiac sympathetic denervation (LCSD) is a surgical antiadrenergic intervention with a strong antiarrhythmic effect, supported by preclinical as well as clinical data. The mechanism of action of LCSD in structurally normal hearts with increased arrhythmic susceptibility (such as those of patients with channelopathies) is not limited to the antagonism of acute catecholamines release in the heart. LCSD also conveys a strong anti-fibrillatory action that was first demonstrated over 40 years ago and provides the rationale for its use in almost any cardiac condition at increased risk of ventricular fibrillation. The molecular mechanisms involved in the final antiarrhythmic effect of LCSD turned out to be much broader than anticipated. Beside the vagotonic effect at different levels of the neuraxis, other new mechanisms have been recently proposed, such as the antagonism of neuronal remodeling, the antagonism of neuropeptide Y effects, and the correction of neuronal nitric oxide synthase (nNOS) imbalance. The beneficial effects of LCSD have never been associated with a detectable deterioration of cardiac performance. Finally, patients express a high degree of satisfaction with the procedure. In this review, we focus on the rationale, results and our personal approach to LCSD in patients with channelopathies such as long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.
Collapse
Affiliation(s)
- Veronica Dusi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy.,Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy.,Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| |
Collapse
|
21
|
Abstract
Lead extraction procedures have a low but real risk of major complications, such as superior vena cava tear and cardiac tamponade. Complications during lead removal are commonly related to lead binding sites, lead malposition, and lead perforation. Lead extraction imaging may indicate lead vascular binding sites, lead position, and perforation. Several imaging modalities are available, including chest radiograph, cardiac computed tomography, and echocardiography. The information provided by various imaging modalities will help assess the challenges of each lead extraction procedure and allows for better preprocedure planning.
Collapse
Affiliation(s)
- Pierce J Vatterott
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA.
| | - Imran S Syed
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
| | - Akbar H Khan
- United Heart & Vascular Clinic, Allina Health System, 225 North Smith Avenue, Suite 400, St Paul, MN 55102, USA
| |
Collapse
|
22
|
Rana BS, Robinson S, Francis R, Toshner M, Swaans MJ, Agarwal S, de Silva R, Rana AA, Nihoyannopoulos P. Tricuspid regurgitation and the right ventricle in risk stratification and timing of intervention. Echo Res Pract 2019; 6:R25-R39. [PMID: 30763278 PMCID: PMC6410762 DOI: 10.1530/erp-18-0051] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 11/08/2022] Open
Abstract
Tricuspid regurgitation natural history and treatment remains poorly understood. Right ventricular function is a key factor in determining prognosis, timing for intervention and longer-term outcome. The right ventricle is a thin walled chamber with a predominance of longitudinal fibres and a shared ventricular septum. In health, the low-pressure pulmonary circulation results in a highly compliant RV well equipped to respond to changes in preload but sensitive to even small alterations in afterload. In Part 1 of this article, discussion focuses on key principles of ventricular function assessment and the importance of right ventricular chamber size, volumes and ejection fraction, particularly in risk stratification in tricuspid regurgitation. Part 2 of this article provides an understanding of the causes of tricuspid regurgitation in the contemporary era, with emphasis on key patient groups and their management.
Collapse
Affiliation(s)
- Bushra S Rana
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Shaun Robinson
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Rajeevan Francis
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK.,Teaching Hospital Batticaloa, Faculty of Health-Care Sciences, Eastern University, Batticaloa, Sri Lanka
| | - Mark Toshner
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Martin J Swaans
- Cardiac Imaging Unit, Cardiology Department, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Sharad Agarwal
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Ravi de Silva
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Amer A Rana
- Division of Respiratory Medicine, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Petros Nihoyannopoulos
- Department of Cardiology, Hammersmith Hospital, Imperial College Hospital NHS Trust, London, UK
| |
Collapse
|
23
|
Garcia R, Inal S, Favreau F, Jayle C, Hauet T, Bruneval P, Kerforne T, Hajj-Chahine J, Degand B. Subcutaneous cardioverter defibrillator has longer time to therapy but is less cardiotoxic than transvenous cardioverter defibrillator. Study carried out in a preclinical porcine model. Europace 2019; 20:873-879. [PMID: 28460030 DOI: 10.1093/europace/eux074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/21/2017] [Indexed: 01/04/2023] Open
Abstract
Aims Totally subcutaneous implantable cardioverter defibrillator (S-ICD) delivers higher shock energy and can have longer time to therapy compared to transvenous implantable cardioverter defibrillator (T-ICD). Aim of the study was to compare time to therapy and to investigate cardiac, cerebral and systemic injuries of S-ICD and T-ICD shocks delivered after ventricular fibrillation (VF) induction. Methods and results Fourteen pigs were randomly implanted with a S-ICD (n = 7) or a T-ICD (n = 7). Five VF episodes were induced in each pig. For each VF episode, up to two shocks could be delivered by the T-ICD or the S-ICD to terminate the arrhythmia. Cardiac, systemic, and cerebral toxicity were monitored. Mean time to therapy was longer in the S-ICD group compared to the T-ICD group (19[18; 23] s vs. 9 [7; 10] s; P = 0.001, respectively). High-sensitivity troponin T levels were significantly higher in the T-ICD group from 1 to 24 h after the procedure (P ≤ 0.02). Creatine phosphokinase activity levels were significantly higher in the S-ICD group, at 3, 6, and 24 h after the procedure (P ≤ 0.05). Lactate levels were not significantly different between groups. S100 protein level was similar in both groups at 1 h after the procedure and then decreased in the T-ICD group compared to the S-ICD group (P = 0.04). Conclusions Time to therapy in S-ICD was twice as long as for T-ICD, but didn't induce relevant brain injury. Conversely, S-ICD shocks were less cardiotoxic than T-ICD shocks.
Collapse
Affiliation(s)
- Rodrigue Garcia
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, Poitiers 86021, France.,Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France
| | - Sofiane Inal
- Inserm U1082, Poitiers, 86000, France.,CHU de Poitiers, Service de Biochimie, Poitiers 86000, France
| | - Frederic Favreau
- Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France.,Inserm U1082, Poitiers, 86000, France.,CHU de Poitiers, Service de Biochimie, Poitiers 86000, France
| | - Christophe Jayle
- Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France.,Inserm U1082, Poitiers, 86000, France.,MOPICT Plateform 'Experimental Surgery and Transplantation', INRA, Domaine Expérimental du Magneraud, Surgères 17700 France.,CHU de Poitiers, Service de chirurgie cardio-thoracique, 2 rue de la Milétrie, Poitiers 86021, France
| | - Thierry Hauet
- Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France.,Inserm U1082, Poitiers, 86000, France.,CHU de Poitiers, Service de Biochimie, Poitiers 86000, France.,MOPICT Plateform 'Experimental Surgery and Transplantation', INRA, Domaine Expérimental du Magneraud, Surgères 17700 France
| | - Patrick Bruneval
- HEGP, APHP, Service d'anatomie-pathologie, 20 Rue Leblanc, Paris 75015, France
| | - Thomas Kerforne
- CHU de Poitiers, Service d'Anesthésie et Réanimation, 2 rue de la Milétrie, Poitiers 86021, France
| | - Jamil Hajj-Chahine
- CHU de Poitiers, Service de chirurgie cardio-thoracique, 2 rue de la Milétrie, Poitiers 86021, France
| | - Bruno Degand
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, Poitiers 86021, France
| |
Collapse
|
24
|
Rodríguez‐Mañero M, Kreidieh B, Ibarra‐Cortez SH, Álvarez P, Schurmann P, Dave AS, Valderrábano M. Coronary vein defibrillator coil placement in patients with high defibrillation thresholds. J Arrhythm 2019; 35:79-85. [PMID: 30805047 PMCID: PMC6373648 DOI: 10.1002/joa3.12136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Elevated defibrillation threshold (DFT) occurs in 2%-6% of patients undergoing implantable cardioverter defibrillator (ICD) implantation. Adding a defibrillation coil in the coronary sinus (CS) or its branches can result in substantial reductions in the mean DFT. However, data regarding acute success and long-term stability remain lacking. We report our experience with this bailout strategy. METHODS Patients with elevated DFT at implantation (safety margin at implantation <10 J) and those with failed ICD shocks for ventricular arrhythmias (VA) referred for high DFT underwent placement of an additional defibrillation coil in the CS. DFT testing was performed at the completion of the implantation procedure. External potentially reversible factors were excluded. High-output devices were systematically used. RESULTS Four patients with high DFT at implantation and two with several failed shock attempts underwent placement of a defibrillation coil in the CS. Mean age was 41.8 (23-78). They presented a mean LVEF of 21% (15-30), QRS-complex duration of 109.8 milliseconds (87-168), body surface area of 1.96 m2 (1.45-2.58), and a mean R wave of 16.3 mV (8-27). Defibrillation coil implantation in the CS (final shocking configuration of right ventricle as anode and left ventricle (LV) plus can as cathode) was associated with successful DFT testing in all. Three patients had a concomitant LV lead for biventricular pacing. During a mean follow-up of 54.67 months (10-118), two patients experienced successful ICD shocks for VA (one of them also presented inappropriate shocks because of the fast conducting atrial fibrillation). CONCLUSIONS Positioning of a defibrillation coil in the CS can result in a substantial reduction in mean DFT and associates with optimal long-term stability.
Collapse
Affiliation(s)
- Moisés Rodríguez‐Mañero
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
- Cardiology DepartmentComplejo Hospital Universitario de SantiagoSantiago de CompostelaSpain
- IDIS (Instituto para el Desarrollo e Integración de la Salud)Santiago de CompostelaSpain
- CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares)Santiago de CompostelaSpain
| | - Bahij Kreidieh
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Sergio H. Ibarra‐Cortez
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Paulino Álvarez
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Paul Schurmann
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Amish S. Dave
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| |
Collapse
|
25
|
Ebrille E, Chang JD, Zimetbaum PJ. Tricuspid Valve Dysfunction Caused by Right Ventricular Leads. Card Electrophysiol Clin 2018; 10:447-452. [PMID: 30172281 DOI: 10.1016/j.ccep.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tricuspid regurgitation is increasingly recognized as a clinically significant valvular condition. The role of multiple pacemaker and implantable cardiac defibrillator leads in distortion of the valve structure and the risk of trauma to the valve and subvalvular apparatus with lead extraction contribute to the development of tricuspid regurgitation (TR). There is a clinical imperative to better understand the optimal way to diagnose lead-related TR, risk factors for the development of TR, and optimal strategies to mitigate this problem.
Collapse
Affiliation(s)
- Elisa Ebrille
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA
| | - James D Chang
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA
| | - Peter J Zimetbaum
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA.
| |
Collapse
|
26
|
Method for preclinical pathology evaluation and analysis of cardiovascular implantable electronic device implant sites. Cardiovasc Pathol 2018; 36:44-52. [DOI: 10.1016/j.carpath.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/23/2018] [Accepted: 05/11/2018] [Indexed: 11/22/2022] Open
|
27
|
Trankle CR, Gertz ZM, Koneru JN, Kasirajan V, Nicolato P, Bhardwaj HL, Ellenbogen KA, Kalahasty G. Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:845-853. [PMID: 29757467 DOI: 10.1111/pace.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
Collapse
Affiliation(s)
- Cory R Trankle
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary M Gertz
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jayanthi N Koneru
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Nicolato
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Hem L Bhardwaj
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
28
|
Varvarousis D, Goulas N, Polytarchou K, Psychari SN, Paravolidakis K, Konstantinidou A, Tsoukalas D, Vlad D, Bouki K, Kotsakis A. Biomarkers of Myocardial Injury and Inflammation after Permanent Pacemaker Implantation: The Lead Fixation Type Effect. J Atr Fibrillation 2018; 10:1798. [PMID: 29988295 DOI: 10.4022/jafib.1798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 11/10/2022]
Abstract
Background Permanent pacemaker implantation is accompanied by minor myocardial damage, indicated by elevated serum levels of cardiac biomarkers. Aim of this prospective study was to comparably investigate the lead fixation type effect on the extent of myocardial injury and inflammation following pacemaker implantation, and to assess the possible clinical implications. Methods Cardiac troponin I (cTnI) and C-reactive protein (CRP) were measured at baseline, 6 and 24h after implantation in 101 patients, categorized into the active and passive lead fixation group. Patients were followed up for clinical adverse events or abnormal pacing parameters at 24h, 7 and 30 days post-procedure. Results cTnI increased at 6h post-procedure (p<0.05) in 23.8% of patients, and returned to baseline after 24h. The passive group demonstrated significantly higher cTnI at 6h compared to the active group (p=0.006). CRP increased significantly at 6h, and maintained an upward trend after 24h (p<0.01) in both groups. The active group demonstrated significantly higher CRP at 6h compared to the passive group. We did not identify an association of positive biomarkers with adverse events. Conclusion cTnI and CRP can increase early after permanent pacemaker implantation, indicating mechanical myocardial injury and inflammation. The extent of these biomarkers elevation depends on the lead fixation type, and is not related to worse short-term prognosis.
Collapse
Affiliation(s)
- Dimitrios Varvarousis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Nikolaos Goulas
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Kali Polytarchou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Stavroula N Psychari
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantinos Paravolidakis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Agapi Konstantinidou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Dionysios Tsoukalas
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Delia Vlad
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantina Bouki
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Athanasios Kotsakis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| |
Collapse
|
29
|
Kwaśniewski W, Filipecki A, Orszulak M, Orszulak W, Urbańczyk D, Roczniok R, Trusz-Gluza M, Mizia-Stec K. Risk factors and prognostic role of an electrical storm in patients after myocardial infarction with an implanted ICD for secondary prevention. Arch Med Sci 2018; 14:500-509. [PMID: 29765434 PMCID: PMC5949907 DOI: 10.5114/aoms.2016.59702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/26/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The aim of our study was to determine the risk factors for electrical storm (ES) and to assess the impact of ES on the long-term prognosis in patients after myocardial infarction (MI) with an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD). MATERIAL AND METHODS We retrospectively analyzed 416 patients with coronary artery disease after MI who had an implanted ICD for secondary prevention of SCD. Fifty (12%) patients had one or more incidents of an electrical storm - the ES (+) group. We matched the reference group of 47 patients from 366 ES (-) patients. RESULTS We analyzed 3,408 episodes of ventricular arrhythmias: 3,148 ventricular tachyarrhythmic episodes in the ES (+) group (including 187 episodes of ES) and 260 in the ES (-) group. Multivariate logistic regression showed that inferior wall MI (RR = 3.98, 95% CI: 1.52-10.41) and the absence of coronary revascularization (RR = 2.92, 95% CI: 1.18-7.21) were independent predictors of ES (p = 0.0014). During 6-year observation of 97 patients, there were 39 (40%) deaths: 25 (50%) subjects in the ES (+) group and 14 (30%) in the ES (-) group (p = 0.036). Independent predictors of death were: the occurrence of ES (HR = 1.93), older age (HR = 1.06), and lower left ventricular ejection fraction (HR = 0.95) (for all p < 0.001). CONCLUSIONS Electrical storm in patients after MI with ICD for secondary prevention is a relatively common phenomenon and has a negative prognostic significance. Myocardial infarction of the inferior wall and the absence of coronary revascularization are predisposing factors for the occurrence of an ES.
Collapse
Affiliation(s)
| | - Artur Filipecki
- First Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Michał Orszulak
- First Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Witold Orszulak
- First Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Dagmara Urbańczyk
- First Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Robert Roczniok
- Department of Statistics and Methodology, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Maria Trusz-Gluza
- First Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | |
Collapse
|
30
|
Sadek MM, Cooper JM, Frankel DS, Santangeli P, Epstein AE, Marchlinski FE, Schaller RD. Utility of intracardiac echocardiography during transvenous lead extraction. Heart Rhythm 2017; 14:1779-1785. [DOI: 10.1016/j.hrthm.2017.08.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 11/25/2022]
|
31
|
Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
Collapse
Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | | |
Collapse
|
32
|
Kim J, Hwang J, Choi JH, Choi HI, Kim MS, Jung SH, Nam GB, Choi KJ, Lee JW, Kim YH, Kim JJ. Frequency and clinical impact of retained implantable cardioverter defibrillator lead materials in heart transplant recipients. PLoS One 2017; 12:e0176925. [PMID: 28464008 PMCID: PMC5413001 DOI: 10.1371/journal.pone.0176925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/08/2017] [Indexed: 12/31/2022] Open
Abstract
End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.
Collapse
Affiliation(s)
- Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jongmin Hwang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo-In Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
33
|
Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation. J Am Coll Cardiol 2017; 69:2331-2341. [DOI: 10.1016/j.jacc.2017.02.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
|
34
|
Padmanabhan D, Asirvatham SJ. Lead Extraction: The Importance of Preparation and Remaining Opportunities. J Cardiovasc Electrophysiol 2017; 28:474-476. [PMID: 28176412 DOI: 10.1111/jce.13173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Deepak Padmanabhan
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
35
|
Wilson D, Moehlis J. Toward a More Efficient Implementation of Antifibrillation Pacing. PLoS One 2016; 11:e0158239. [PMID: 27391010 PMCID: PMC4938213 DOI: 10.1371/journal.pone.0158239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
We devise a methodology to determine an optimal pattern of inputs to synchronize firing patterns of cardiac cells which only requires the ability to measure action potential durations in individual cells. In numerical bidomain simulations, the resulting synchronizing inputs are shown to terminate spiral waves with a higher probability than comparable inputs that do not synchronize the cells as strongly. These results suggest that designing stimuli which promote synchronization in cardiac tissue could improve the success rate of defibrillation, and point towards novel strategies for optimizing antifibrillation pacing.
Collapse
Affiliation(s)
- Dan Wilson
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106, United States of America
- * E-mail:
| | - Jeff Moehlis
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106, United States of America
| |
Collapse
|
36
|
Jo U, Kim J, Hwang YM, Lee JH, Kim MS, Choi HO, Lee WS, Kwon CH, Ko GY, Yoon HK, Nam GB, Choi KJ, Kim YH. Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction. Korean Circ J 2016; 46:186-96. [PMID: 27014349 PMCID: PMC4805563 DOI: 10.4070/kcj.2016.46.2.186] [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] [Received: 07/09/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction. Subjects and Methods The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups. Results The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B. Conclusion Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.
Collapse
Affiliation(s)
- Uk Jo
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Mi Hwang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyun Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Woo-Seok Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hee Kwon
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
37
|
|
38
|
Sagone A. Electrical Storm: Incidence, Prognosis and Therapy. J Atr Fibrillation 2015; 8:1150. [PMID: 27957218 DOI: 10.4022/jafib.1150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/19/2015] [Accepted: 12/24/2015] [Indexed: 01/22/2023]
Abstract
The term "electrical storm" indicates a life-threatening clinical condition characterized by the recurrence of hemodynamically unstable ventricular tachycardia and/or ventricular fibrillation, in particular in patients with ICD implanted for primary or secondary prevention. Although there isn't a shared definition of electrical storm, nowadays the most accepted definition refers to three or more separate arrhythmia episodes leading to ICD therapies including antitachycardia pacing or shock occurring over a single 24 hours' time period. Clinical presentation can be dramatic and triggering mechanism are not clear at all yet, but electrical storm is associated with high mortality rates and low patients quality of life, both in the acute phase and in the long term. The first line therapy is based on antiarrhythmic drugs to suppress electrical storm, but in refractory patients, interventions such as catheter ablation or in some cases surgical cardiac sympathetic denervation might be helpful. Anyhow, earlier interventional management can lead to better outcomes than persisting with antiarrhythmic pharmacologic therapy and, when available, an early interventional approach should be preferred.
Collapse
Affiliation(s)
- Antonio Sagone
- Cardiology Department, Luigi Sacco Hospital, Milan, Italy
| |
Collapse
|
39
|
Aytemir K, Yorgun H, Canpolat U, Şahiner ML, Kaya EB, Evranos B, Özer N. Initial experience with the TightRail™ Rotating Mechanical Dilator Sheath for transvenous lead extraction. Europace 2015; 18:1043-8. [PMID: 26467403 DOI: 10.1093/europace/euv245] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/17/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS In parallel with increasing implantation rates and patients' longer life expectancy, the need for transvenous lead extraction (TLE) as a specialized procedure has shown a significant growth over years. Herein, we aimed to present our initial experience in TLE by using a novel TightRail™ Rotating Mechanical Dilator Sheath. METHODS AND RESULTS Between October 2014 and March 2015, a total of 42 leads in 23 patients were removed at our tertiary referral centre. All of the extracted leads were >12 months old and indications for extraction were based on the recommendations of the Heart Rhythm Society. The leads were removed by using the TightRail™ Mechanical Dilator Sheath (Spectranetics Corporation) with the rotational cutting force only. Indications for lead removal included cardiac device infection in 12 (52.2%) cases, lead malfunction in the 10 (43.5%) cases, and upgrade to cardiac resynchronization therapy-defibrillator (CRT-D) in the remaining 1 case (4.3%). The extracted devices were pacemaker in 10 (43.4%) cases, implantable cardioverter-defibrillator (ICD) in 7 (30.4%) cases, and CRT in the remaining 6 (26.0%) subjects. Among 42 leads, 10 (23.8%) were right ventricular, 14 (33.3%) were atrial, 13 (31.0%) were defibrilator, and 5 (11.9%) were coronary sinus electrodes. The median time from implantation was 72 (18-216) months. Complete procedural success with TightRail™ system alone was achieved in 22 (95.7%) patients (41/42 leads) and overall clinical success was 100%. One right ventricular lead was completely removed with the help of femoral snare. All the patients were discharged uneventfully without any complication. CONCLUSION Our preliminary data with small sample size show that TightRail™ Mechanical Dilator Sheath is a new useful tool for chronically implanted pacemaker (PM)/ICD leads. Continued investigation including large patient cohort is required to evaluate success and complication rates in comparison to other tools and techniques.
Collapse
Affiliation(s)
- Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - M Levent Şahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Ergün Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Banu Evranos
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| | - Necla Özer
- Department of Cardiology, Hacettepe University Faculty of Medicine, 06100 Sıhhiye, Ankara, Turkey
| |
Collapse
|
40
|
Meraviglia V, Azzimato V, Colussi C, Florio MC, Binda A, Panariti A, Qanud K, Suffredini S, Gennaccaro L, Miragoli M, Barbuti A, Lampe PD, Gaetano C, Pramstaller PP, Capogrossi MC, Recchia FA, Pompilio G, Rivolta I, Rossini A. Acetylation mediates Cx43 reduction caused by electrical stimulation. J Mol Cell Cardiol 2015; 87:54-64. [PMID: 26264759 DOI: 10.1016/j.yjmcc.2015.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 01/13/2023]
Abstract
Communication between cardiomyocytes depends upon gap junctions (GJ). Previous studies have demonstrated that electrical stimulation induces GJ remodeling and modifies histone acetylase (HAT) and deacetylase (HDAC) activities, although these two results have not been linked. The aim of this work was to establish whether electrical stimulation modulates GJ-mediated cardiac cell-cell communication by acetylation-dependent mechanisms. Field stimulation of HL-1 cardiomyocytes at 0.5 Hz for 24 h significantly reduced connexin43 (Cx43) expression and cell-cell communication. HDAC activity was down-regulated whereas HAT activity was not modified resulting in increased acetylation of Cx43. Consistent with a post-translational mechanism, we did not observe a reduction in Cx43 mRNA in electrically stimulated cells, while the proteasomal inhibitor MG132 maintained Cx43 expression. Further, the treatment of paced cells with the HAT inhibitor Anacardic Acid maintained both the levels of Cx43 and cell-cell communication. Finally, we observed increased acetylation of Cx43 in the left ventricles of dogs subjected to chronic tachypacing as a model of abnormal ventricular activation. In conclusion, our findings suggest that altered electrical activity can regulate cardiomyocyte communication by influencing the acetylation status of Cx43.
Collapse
Affiliation(s)
- Viviana Meraviglia
- Laboratory of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milano, Italy; Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano Italy
| | - Valerio Azzimato
- Laboratory of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Pharmacology, Chemotherapy and Medical Toxicology, Università degli Studi di Milano, Milano, Italy
| | - Claudia Colussi
- Istituto di Patologia Medica, Università Cattolica del SacroCuore, Roma, Italy
| | | | - Anna Binda
- Department of Health Science, University of Milano Bicocca, Monza, Italy
| | - Alice Panariti
- Department of Health Science, University of Milano Bicocca, Monza, Italy
| | - Khaled Qanud
- Department of Physiology, New York Medical College, Valhalla, NY, United States
| | - Silvia Suffredini
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano Italy
| | - Laura Gennaccaro
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano Italy; Department of Life Sciences, University of Parma, Parma, Italy
| | - Michele Miragoli
- CERT, Center of Excellence for Toxicological Research, INAIL, ex ISPESL, University of Parma, Parma, Italy; Humanitas Clinical and Research Center, Rozzano Milano, Italy
| | - Andrea Barbuti
- The PaceLab, Department of Biosciences, Università di Milano, Italy
| | - Paul D Lampe
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Carlo Gaetano
- Division of Cardiovascular Epigenetics, Department of Cardiology, Goethe University, Frankfurt am Main, Germany
| | - Peter P Pramstaller
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano Italy
| | - Maurizio C Capogrossi
- Laboratory of Vascular Pathology, Istituto Dermopatico dell'Immacolata IRCCS, Roma, Italy
| | - Fabio A Recchia
- Department of Physiology, Temple University School of Medicine, Philadelphia, PA, United States; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giulio Pompilio
- Laboratory of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Ilaria Rivolta
- Department of Health Science, University of Milano Bicocca, Monza, Italy
| | - Alessandra Rossini
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano Italy.
| |
Collapse
|
41
|
Abstract
Despite the clinical benefit of implantable cardioverter defibrillator (ICD), there is a high frequency of inappropriate ICD therapy associated with impaired quality of life, unwanted health care resource utilization, and adverse clinical outcome. Alternative strategies of ICD programming are needed to reduce the risk of inappropriate and "unnecessary" ICD therapies and to improve patient outcome. In this review, we provide an overview of the rate of inappropriate and appropriate ICD therapies in clinical trials and large registries as well as a review of current trials evaluating novel ICD programming to reduce inappropriate ICD therapy to avoid unnecessary ICD therapy. Based on recent studies including a large randomized trial, we recommend a simple programming approach involving high-rate device therapy beginning at 200 bpm with a 2.5 sec delay for it reduces inappropriate therapy, unnecessary therapy, and all-cause mortality in patients receiving ICD or CRT-D devices for primary prevention indications.
Collapse
Affiliation(s)
- Valentina Kutyifa
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA,
| | | | | |
Collapse
|
42
|
Segreti L, Di Cori A, Soldati E, Zucchelli G, Viani S, Paperini L, De Lucia R, Coluccia G, Valsecchi S, Bongiorni MG. Major predictors of fibrous adherences in transvenous implantable cardioverter-defibrillator lead extraction. Heart Rhythm 2014; 11:2196-201. [DOI: 10.1016/j.hrthm.2014.08.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 11/30/2022]
|
43
|
A systematic review and meta-analysis of the association between implantable cardioverter-defibrillator shocks and long-term mortality. Can J Cardiol 2014; 31:270-7. [PMID: 25746019 DOI: 10.1016/j.cjca.2014.11.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/15/2014] [Accepted: 11/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is unknown whether implantable cardioverter-defibrillator (ICD) discharges actively contribute to a worse prognosis independent of the underlying arrhythmia. There is considerable variability in the reported risk of mortality after appropriate and inappropriate ICD shocks. The aim of our systematic review was to provide a reliable effect size of the association between ICD shock and mortality for both types of therapies. METHODS On the basis of a systematic literature search, 10 studies were considered eligible for inclusion in the analysis, and data on the hazard ratio (HR) of mortality after ICD shock were extracted from each study. RESULTS On pooled analysis, a substantial difference was detected in the risk for subsequent mortality between appropriate and inappropriate shocks. Among patients receiving an appropriate ICD shock, the HR for cardiac death was 2.95 (95% confidence interval [CI], 2.12-4.11; P < 0.001) compared with an HR of 1.71 (95% CI, 1.45-2.02) for those receiving an inappropriate shock. Clinical variables like ejection fraction, New York Heart Association class, and length of follow-up did not affect the HRs in our meta-regression models. CONCLUSIONS Our analysis showed a significant association between appropriate and inappropriate ICD shocks and mortality, with a stronger association for appropriate shocks. Previous trials of ICD therapy reduction programming have shown a significant reduction of inappropriate shocks. The management of appropriate shocks is more challenging and may be optimized by the assessment and treatment of the underlying ventricular arrhythmias. The role of therapies aimed at modifying the arrhythmic substrate and the potential impact on ICD shocks and mortality requires further investigation.
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW To consider the case of need that underpinned the development of the subcutaneous implantable cardioverter-defibrillator (SICD), the preclinical and clinical data obtained so far, its current role and likely future. RECENT FINDINGS The data from prospective clinical evaluation of the device demonstrated safety and efficacy leading to Food and Drug Administration approval. This superseded earlier reports from Europe that raised some clinical concerns, previously anticipated through the introduction of new technology. Recent estimates indicate maybe 55% of patients in routine clinical practice needing an ICD are potentially suitable for a subcutaneous device. SUMMARY The SICD provides a useful alternative for high-energy (ICD) therapy in those deemed at risk and who need defibrillation and in whom there are no indications for cardiac resynchronization, bradycardia support or antitachycardia pacing. There is the possibility of both higher specificity and the avoidance of myo-cellular damage with shock delivery, and if these two aspects play out subcutaneous defibrillation could become an option of choice in many settings.
Collapse
|
45
|
Sivakumar K, Pavithran S, Louis A, Satish R. Implantable cardioverter defibrillator shock embolizes an atrial septal occluder device in Brugada syndrome. Pediatr Cardiol 2014; 34:1886-9. [PMID: 22797521 DOI: 10.1007/s00246-012-0432-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/29/2012] [Indexed: 11/30/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) are indicated in patients with Brugada syndrome with resuscitated ventricular arrhythmias. When these patients have atrial septal defects, they also need closure to prevent paradoxic embolism of thrombus from the defibrillator leads. A 15-year-old boy with Brugada syndrome had transvenous ICD placement along with device closure of a large atrial septal defect. When the defibrillation threshold was checked during device testing, a shock was delivered to terminate the induced ventricular fibrillation. The sudden jerk during this shock resulted in device embolization into the left atrium. The device was successfully retrieved and the defect closed with a larger device. This report discusses this extremely rare association of Brugada syndrome with atrial septal defect, unreported complications after device closure, and successful management of the problem.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, MIOT Hospital, 4/112, Mount Poonamalle Road, Chennai, 600089, India,
| | | | | | | |
Collapse
|
46
|
Larson ER, Porterfield JE, Sagar S, Marmol-Velez J, Panday M, Escobedo D, Michalek J, Ouyang Y, Valvano JW, Pearce JA, Feldman MD. Admittance to detect alterations in left ventricular stroke volume. Heart Rhythm 2014; 11:2075-83. [PMID: 24981870 DOI: 10.1016/j.hrthm.2014.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators monitor intracardiac electrograms (EGMs) to discriminate between ventricular and supraventricular tachycardias. The incidence of inappropriate shocks remains high because of misclassification of the tachycardia in an otherwise hemodynamically stable individual. Coupling EGMs with an assessment of left ventricular (LV) stroke volume (SV) could help in gauging hemodynamics during an arrhythmia and reducing inappropriate shocks. OBJECTIVE The purpose of this study was to use the admittance method to accurately derive LV SV. METHODS Ultrasonic flow probe and LV endocardial crystals were used in canines (n = 12) as the standard for LV SV. Biventricular pacing leads were inserted to obtain admittance measurements. A tetrapolar, complex impedance measurement was made between the Bi-V leads. The real and imaginary components of impedance were used to discard the myocardial component from the blood component to derive instantaneous blood conductance (Gb). Alterations in SV were measured during right ventricular pacing, dopamine infusion, and inferior vena cava occlusion. RESULTS Gb tracks steady-state changes in SV more accurately than traditional magnitude (ie, |Y|, without removal of the muscle signal) during right ventricular pacing and dopamine infusion (P = .004). Instantaneous LV volume also was tracked more accurately by Gb than ∣Y∣ in the subset of subjects that underwent inferior vena cava occlusions (n = 5, P = .025). Finite element modeling demonstrates that admittance shifts more sensitivity of the measurement to the LV blood chamber as the mechanism for improvement (see Online Appendix). CONCLUSION Monitoring LV SV is possible using the admittance method with biventricular pacing leads. The technique could be piggybacked to complement EGMs to determine if arrhythmias are hemodynamically unstable.
Collapse
Affiliation(s)
- Erik R Larson
- Department of Electrical Engineering, University of Texas at Austin, Austin, Texas
| | | | - Sandeep Sagar
- Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Juan Marmol-Velez
- Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Manoj Panday
- Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel Escobedo
- Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Joel Michalek
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Yongjian Ouyang
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jonathan W Valvano
- Department of Electrical Engineering, University of Texas at Austin, Austin, Texas
| | - John A Pearce
- Department of Electrical Engineering, University of Texas at Austin, Austin, Texas
| | - Marc D Feldman
- Admittance Technologies, Austin, Texas; Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, Texas.
| |
Collapse
|
47
|
Wilner BR, Coffey JO, Mitrani R, Carrillo RG. Perforated tricuspid valve leaflet resulting from defibrillator leads: a review of the literature. J Card Surg 2014; 29:470-2. [PMID: 24803079 DOI: 10.1111/jocs.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tricuspid valve (TV) perforation is a rare complication after implantable cardioverter defibrillator (ICD) and permanent pacemaker implantation. In reported cases of lead-related TV perforations, patients' present with symptoms months to years postimplantation. We describe a case where a patient presented with signs of severe TV regurgitation secondary to traumatic perforation of the septal leaflet two weeks after ICD implantation and review of the literature associated with this complication.
Collapse
Affiliation(s)
- Bryan R Wilner
- Department of Cardiac Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | |
Collapse
|
48
|
A histological and mechanical analysis of the cardiac lead-tissue interface: implications for lead extraction. Acta Biomater 2014; 10:2200-8. [PMID: 24434537 DOI: 10.1016/j.actbio.2014.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/19/2013] [Accepted: 01/07/2014] [Indexed: 11/21/2022]
Abstract
The major risks of pacemaker and implantable cardioverter defibrillator extraction are attributable to the fibrotic tissue that encases them in situ, yet little is known about the cellular and functional properties of this response. In the present research, we performed a histological and mechanical analysis of human tissue collected from the lead-tissue interface to better understand this process and provide insights for the improvement of lead design and extraction. The lead-tissue interface consisted of a thin cellular layer underlying a smooth, acellular surface, followed by a circumferentially organized collagen-rich matrix. 51.8±4.9% of cells were myofibroblasts via immunohistochemistry, with these cells displaying a similar circumferential organization. Upon mechanical testing, samples exhibited a triphasic force-displacement response consisting of a toe region during initial tensioning, a linear elastic region and a yield and failure region. Mean fracture load was 5.6±2.1N, and mean circumferential stress at failure was 9.5±4.1MPa. While the low cellularity and fibrotic composition of tissue observed herein is consistent with a foreign body reaction to an implanted material, the significant myofibroblast response provides a mechanical explanation for the contractile forces complicating extractions. Moreover, the tensile properties of this tissue suggest the feasibility of circumferential mechanical tissue disruption, similar to balloon angioplasty devices, as a novel approach to assist with lead extraction.
Collapse
|
49
|
Avula MN, Rao AN, McGill LD, Grainger DW, Solzbacher F. Modulation of the foreign body response to implanted sensor models through device-based delivery of the tyrosine kinase inhibitor, masitinib. Biomaterials 2013; 34:9737-46. [PMID: 24060424 DOI: 10.1016/j.biomaterials.2013.08.090] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Abstract
The host foreign body response (FBR) adversely effects the performance of numerous implanted biomaterials especially biosensors, including clinically popular glucose-monitoring sensors. Reactive formation of a fibrous capsule around implanted sensors hinders the transport of essential analytes to the sensor from the surrounding tissue, resulting in loss of glucose response sensitivity and eventual sensor failure. Several strategies have sought to mitigate the foreign body response's effects on CGM sensors through the use of local delivery of pharmaceuticals and biomolecules with limited success. This study describes release of a tyrosine kinase inhibitor - masitinib - from the sensor implant to target tissue resident mast cells as key mediators of the FBR. Model implants are coated with a composite polymer hydrophilic matrix that rapidly dissolves upon tissue implantation to deposit slower-degrading polymer microparticles containing masitinib. Matrix dissolution limits coating interference with sensor function while establishing a local controlled-release delivery depot formulation to alter implant tissue pharmacology and addressing the FBR. Drug efficacy was evaluated in a murine subcutaneous pocket implant model. Drug release extends to more than 30 days in vitro. The resulting FBR in vivo, evaluated by implant capsule thickness and inflammatory cell densities at 14, 21, and 28 days, displays statistically significant reduction in capsule thickness around masitinib-releasing implant sites compared to control implant sites.
Collapse
Affiliation(s)
- Mahender Nath Avula
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA
| | | | | | | | | |
Collapse
|
50
|
Sham'a RA, Nery P, Sadek M, Yung D, Redpath C, Perrin M, Sarak B, Birnie D. Myocardial injury secondary to ICD shocks: insights from patients with lead fracture. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:237-41. [PMID: 23998856 DOI: 10.1111/pace.12263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/23/2013] [Accepted: 07/30/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients who receive appropriate implantable cardioverter defibrillator (ICD) shocks have a subsequent adverse prognosis. Most data suggest that patients with inappropriate ICD shocks also have a subsequent adverse prognosis, although this is more controversial. The shocks may be an epiphenomenon, that is, a marker of underlying disease progression; however, it cannot be excluded that shocks cause direct myocardial damage. This latter question is difficult to clarify as the arrhythmia provoking the shock can also cause troponin release. Inappropriate shocks secondary to lead fracture are an ideal situation to examine this question; any troponin release in an otherwise well and hemodynamically stable patient, is likely due directly to the shocks. METHODS All patients with Fidelis lead fracture admitted to our institution with inappropriate shocks were included in this study. Troponin (I or T) was considered positive if the level was above the 99th percentile reference cutoff. RESULTS Elevated troponin levels were recorded in 16 of 22 patients (73%). Patients with elevated troponin received a higher number of shocks (20.3 ± 30.1 vs 5.3 ± 4.8, P = 0.07) compared with patients with normal troponin. Very elevated troponin levels (>0.8 mcg/L) were seen in five of 22 (22%) patients. The mean peak troponin level for these five patients was 7.06 ± 8.56 mcg/L; two patients had troponin levels that would be expected from a medium-sized myocardial infarction or severe myocarditis. CONCLUSION Troponin elevation occurred in the majority of our patients after inappropriate ICD discharges secondary to lead fracture. This indicates that ICD shocks can cause myocardial injury.
Collapse
Affiliation(s)
- Raed Abu Sham'a
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|