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Boluk A, Sokolski M, Rakowski M, Jura M, Bochenek M, Cielecka M, Przybylski R, Zakliczyński M. Pacemaker Implantation Following Heart Transplantation - Incidence and Risk Factors. Single-Center Experience. Transplant Proc 2024; 56:851-853. [PMID: 38697907 DOI: 10.1016/j.transproceed.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Bradyarrhythmias, requiring pacemaker (PM) implantation, are common complications following orthotopic heart transplantation (HTx). Currently used heart transplantation methods are primarily the bicaval technique and the total heart transplantation technique. The aim of the study was to assess the incidence and risk factors, including donor parameters, of conduction disorders requiring pacing after HTx. METHODS A population of 111 (52 ± 13 years, 91 (82%) men) heart recipients was divided into a group requiring PM implantation post-HTx and a group not requiring PM. We compared groups in terms of donor parameters, time of graft ischemia, transport and transplantation, and surgical techniques as the potential risk factors for significant bradyarrhythmias. RESULTS Ten of 111 patients with HTx (9%) required PM implantation. The indication in 7 cases was sinus node dysfunction (SND), in 3 patients it was complete atrioventricular block (AV-block). In the PM group, the age of 48 ± 6 vs 40 ± 11 years (P = .0227) and the body mass index (BMI) 28 ± 3 vs 26 ± 4 kg/m2 (P = .0297) of the donor were significantly higher. There was no influence of organ transport time, ischemia time, and transplantation time. All patients requiring PM implantation were transplanted using the bicaval anastomosis: 10 (100%) vs 71 (70%) in the group not requiring PM (P = .044). CONCLUSIONS The need for PM implantation post-HTx despite using new techniques is still common, especially in the group operated with the bicaval method. In addition, higher donor's age and BMI are risk factors of PM implantation, what is of importance as qualification criteria of donor hearts have been gradually extended.
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Affiliation(s)
- Anna Boluk
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland.
| | - Mateusz Sokolski
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Rakowski
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland
| | - Maksym Jura
- Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland; Institute of Heart Disease, Cardiology Department, University Hospital, Wroclaw, Poland
| | - Maciej Bochenek
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Cielecka
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Roman Przybylski
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Zakliczyński
- Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland; Institute of Heart Disease, Wroclaw Medical University, Wroclaw, Poland
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Bahrami F, Sattartabar B, Larti F, Rahmanian M, Mollazadeh R. Late recognition of cardiac implantable electronic device misplacement in left ventricle: a case report. Future Cardiol 2024; 20:269-274. [PMID: 38899509 PMCID: PMC11318706 DOI: 10.1080/14796678.2024.2363627] [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: 12/29/2023] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Cardiac electronic device implantation may be associated with complications. Case Summary: This is a report of inadvertent implantation of implantable cardioverter-defibrillator lead through an unrecognized sinus venosus atrial septal defect into the left ventricle that was not diagnosed early after implantation. Six months later chest x-ray showed an abnormal lead course that was confirmed with echocardiography as to be in the left ventricle. Surgical removal of the implantable cardioverter-defibrillator lead, repair of atrial septal defect, and correction of abnormal pulmonary venous connections were performed. Meanwhile, follow-up of the patient receiving a new dual chamber permanent pacemaker from the contralateral side and discussion of the aforementioned complication are addressed. Conclusion: Early diagnosis of device implantation complication is of paramount importance and prevents potential catastrophic complications.
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Affiliation(s)
- Fatemeh Bahrami
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
| | - Babak Sattartabar
- Department of Cardiology, Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
| | - Mehrzad Rahmanian
- Department of Cardiothoracic Surgery, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
| | - Reza Mollazadeh
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
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English C, Fan D, Ing F, Cortez D. Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high-risk infected device extraction. J Cardiovasc Electrophysiol 2024; 35:418-421. [PMID: 38213071 DOI: 10.1111/jce.16173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime. METHODS We present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy. RESULTS A 27-year-old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status-post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy-based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser-lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial-mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices. CONCLUSION Our case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices.
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Affiliation(s)
- Carter English
- Pediatric and Adult Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Dali Fan
- Pediatric and Adult Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Frank Ing
- Pediatric and Adult Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Daniel Cortez
- Pediatric and Adult Cardiology, UC Davis Medical Center, Sacramento, California, USA
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Rahmat ZS, Cortez D. Retrievable leadless pacemakers (Aveir VR) may be beneficial in adult patients with congenital heart disease. Indian Pacing Electrophysiol J 2024; 24:57-62. [PMID: 38272181 PMCID: PMC11010452 DOI: 10.1016/j.ipej.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Congenital heart disease may present in up to 1.6 % of newborns. Given high burden of pacing need in adult patients with repaired congenital heart disease and availability of different pacing options, more information on outcomes of newer pacemaker types are needed. Retrievable leadless pacemaker implants in adult congenital patients have not been described. METHODS Retrospective review of three Aveir (Abbott) retrievable leadless pacemaker implants were reviewed at the UC Davis Medical Center. All patients underwent implant via femoral access. RESULTS All patients had one deployment only, after mapping prior. No complications occurred. Implant thresholds were 0.5 V (V) @0.2msilliseconds (ms) for patients 1 and 2 and 1 V @0.4 ms for patient 3. With impedances between 500 and 1290 Ω. Sensing was 5.5-8 mV (mV). Follow-up occurred up to one year (for two patients) with similar values overall. The predicted longevities of each device were between 22.6 and >25 years. CONCLUSION Safety and short-mid-term parameters of retrievable leadless pacemaker implantation is reported in three patients with adult congenital heart disease.
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Affiliation(s)
- Zainab Syyeda Rahmat
- Department of Electrophysiology, UC Davis Medical Center, USA; Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Pakistan
| | - Daniel Cortez
- Department of Electrophysiology, UC Davis Medical Center, USA.
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Zangiabadian M, Sharifian Ardestani M, Rezaee M, Saberi Sharbabaki E, Nikoohemmat M, Eslami M, Goudarzi K, Sanjari M, Namazi MH, Akbarzadeh MA, Aletaha A. Fragmented QRS, a strong predictor of mortality and major arrhythmic events in patients with nonischemic cardiomyopathy: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e1888. [PMID: 38357482 PMCID: PMC10865277 DOI: 10.1002/hsr2.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims Fragmented QRS (fQRS), which is associated with rhythm disturbances, can predispose the heart to fatal ventricular arrhythmias. Recently, accumulating studies indicates that fQRS is associated with poor prognosis in various types of cardiomyopathies. Therefore, we assessed the association between fQRS with all-cause mortality and major arrhythmic events (MAEs) in patients with nonischemic cardiomyopathy, in this systematic review and meta-analysis study. Methods We performed a comprehensive search in databases of PubMed/Medline, EMBASE, and Web of Science from the beginning to December 31, 2022. Published observational studies (cohorts, case-control, or analytical cross-sectional studies) were included that report the prognostic value of fQRS in patients with different types of nonischemic cardiomyopathies for MAEs (sudden cardiac death, sudden cardiac arrest, sustained ventricular tachycardia [VT], ventricular fibrillation [VF], and appropriate shock) and all-cause mortality. We pooled risk ratios (RRs) through raw data and adjusted hazard ratios (aHRs) using "Comprehensive Meta-Analysis" software, Version 2.0. Results Nineteen cohort and three analytical cross-sectional studies were included in this meta-analysis involving a total of 4318 subjects with nonischemic cardiomyopathy (1279 with fQRS and 3039 without fQRS). FQRS was significantly associated with an increased risk of all-cause mortality in patients with nonischemic cardiomyopathy (pooled RR: 1.920; 95% confidence interval [CI]: 1.388-2.656, p < 0.0001/pooled HR: 1.729; 95% CI: 1.327-2.251, p < 0.0001). Also, the risk of developing MAEs in the presence of fQRS was significantly increased (pooled RR: 2.041; 95% CI: 1.644-2.533, p < 0.0001/pooled HR: 3.626; 95% CI: 2.119-6.204, p < 0.0001). In the subgroup analysis, the strongest association between fQRS presence and increased MAEs was observed in patients with hypertrophic cardiomyopathy (HCM) (pooled RR: 3.44; 95% CI: 2.07-5.71, p < 0.0001/pooled HR: 3.21; 95% CI: 2.04-5.06, p < 0.0001). Conclusion Fragmented QRS could be a prognostic marker for all-cause mortality and MAEs in patients with various types of nonischemic cardiomyopathies, particularly HCM.
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Affiliation(s)
- Moein Zangiabadian
- Endocrinology and Metabolism Research CenterKerman University of Medical SciencesKermanIran
| | | | - Malihe Rezaee
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Mahdi Nikoohemmat
- School of MedicineArak University of Medical SciencesArakMarkaziIran
| | - Mohammad Eslami
- Department of Pathology, Imam Hossein Educational Hospital, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Kian Goudarzi
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Mojgan Sanjari
- Endocrinology and Metabolism Research CenterKerman University of Medical SciencesKermanIran
| | - Mohammad Hasan Namazi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Azadeh Aletaha
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
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Yaghoobian R, Hosseini Dolama R, Soleimani H, Saeidi S, Mashayekhi M, Mirzayi P, Alavi Tabatabaei G, Hosseini K. Incidence of atrioventricular block after isolated coronary artery bypass grafting: a systematic review and pooled-analysis. Front Cardiovasc Med 2023; 10:1225833. [PMID: 37593149 PMCID: PMC10427724 DOI: 10.3389/fcvm.2023.1225833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023] Open
Abstract
Background and objectives Atrioventricular block (AVB) is a serious complication following coronary artery bypass grafting (CABG) surgery, and its high-grade form may necessitate the implantation of a permanent pacemaker (PPM). AVB is associated with increased morbidity and mortality rates. This study aims to estimate the incidence of AVB and subsequent PPM implantation after isolated CABG surgery. Material and methods We searched electronic databases of PubMed, Embase, and Scopus from inception to 18 November 2022. Clinical trials and observational studies reporting the incidence of post-CABG AVB or subsequent PPM implantation in adult patients were included. The total incidence for all included outcomes was calculated using the inverse variance method, and the I2 statistic was reported to evaluate the heterogeneity of studies. Results A total of 28 studies met the inclusion criteria. Four studies [3 cohorts, 1 randomized controlled trial (RCT)] reported AVB without specifying its type; one (cohort) reported different degrees of AVB, 20 (12 cohorts, 8 RCTs) reported complete heart block (CHB) (or AVB requiring temporary pacing), and nine (8 cohorts, 1 RCT) reported the number of PPM inserted due to AVB. The pooled incidence of AVB, CHB (or AVB requiring temporary pacing), and PPM due to AVB was 1.16%, 1.73%, and 0.58%, respectively. Meta-regression analysis revealed that age, gender, diabetes, hypertension, hyperlipidemia, or smoking were not significantly associated with AVB, CHB, or PPM implantation. Conclusion This study highlights the incidence of AVB and the need for PPM implantation following CABG surgery. The findings emphasize the importance of postoperative monitoring and surveillance to improve patient outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022377181, identifier PROSPERO CRD42022377181.
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Affiliation(s)
- Ramin Yaghoobian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hosseini Dolama
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Soleimani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeidi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mashayekhi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Mirzayi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazaal Alavi Tabatabaei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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