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Santobuono VE, Carella MC, Guaricci AI, Carulli E, Basile P, Dicorato MM, Ciccone MM, Forleo C. The Beneficial Role of Telemedicine for Arrhythmic Risk Stratification in Asymptomatic Brugada Syndrome: An Exemplary Case Report. Telemed J E Health 2024; 30:1499-1503. [PMID: 38294864 DOI: 10.1089/tmj.2023.0620] [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] [Indexed: 02/01/2024] Open
Abstract
Telemedicine and remote monitoring devices, including implantable loop recorders (ILR), are increasingly adopted in the cardiologic setting. These are valuable tools in the arrhythmic stratification of patients at risk of sudden cardiac death, providing a tailored therapeutic management to prevent lethal arrhythmias. We report a case of an asymptomatic 18-year-old boy with a family history of syncope and cardiac arrest, who had a diagnosis of Brugada syndrome with an inducible type 1 pattern and carrier of a missense mutation of the SCN5A gene. In light of the risk factors, although not recommended by current guidelines, we decided to proceed with the implantation of an ILR with remote monitoring service. A few months later, an episode of asymptomatic sustained polymorphic ventricular tachycardia was promptly observed by the remote monitoring, leading to a timely implantation of a subcutaneous cardiac implantable defibrillator.
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MESH Headings
- Humans
- Male
- Brugada Syndrome/diagnosis
- Brugada Syndrome/genetics
- Brugada Syndrome/therapy
- Adolescent
- Telemedicine/methods
- Defibrillators, Implantable
- Risk Assessment/methods
- NAV1.5 Voltage-Gated Sodium Channel/genetics
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/therapy
- Electrocardiography
- Electrocardiography, Ambulatory/instrumentation
- Electrocardiography, Ambulatory/methods
- Mutation, Missense
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
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Affiliation(s)
- Vincenzo Ezio Santobuono
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
| | - Maria Cristina Carella
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
- Internal Medicine Section, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
| | - Andrea Igoren Guaricci
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
| | - Eugenio Carulli
- Internal Medicine Section, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
- Cardiology Unit, "Madonna delle Grazie" Hospital, Matera, Italy
| | - Paolo Basile
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
| | - Marco Maria Dicorato
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
| | - Cinzia Forleo
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, University Hospital Consortium, Polyclinic of Bari, Bari, Italy
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Nagy B, Pál-Jakab Á, Kiss B, Orbán G, Sélley TL, Dabasi-Halász Z, Móka BB, Gellér L, Merkely B, Zima E. Remote Management of Patients with Cardiac Implantable Electronic Devices during the COVID-19 Pandemic. J Cardiovasc Dev Dis 2023; 10:214. [PMID: 37233181 PMCID: PMC10219157 DOI: 10.3390/jcdd10050214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
Remote monitoring (RM) is the newest function of cardiac implantable electronic devices (CIEDs). In our observational retrospective analysis, we aimed to assess whether telecardiology could be a safe alternative to routine outpatient examinations during the COVID-19 pandemic. The in- and outpatient visits, the number of acute cardiac decompensation episodes, the RM data from CIEDs, and general condition were examined via questionnaires (KCCQ, EQ-5D-5L). Regarding the enrolled 85 patients, the number of personal patient appearances was significantly lower in the year following the pandemic outbreak compared to the previous year (1.4 ± 1.4 and 1.9 ± 1.2, p = 0.0077). The number of acute decompensation events was five before and seven during lockdown (p = 0.6). Based on the RM data, there was no significant difference in heart failure (HF) markers (all related p > 0.05); only patient activity increased after restrictions were lifted compared to that before the lockdown (p = 0.03). During restrictions, patients reported increased anxiety and depression compared to their previous state (p < 0.001). There was no subjective change in the perception of HF symptoms (p = 0.7). Based on the subjective perception and CIED data, the quality of life of patients with CIED did not deteriorate during the pandemic, but their anxiety and depression intensified. Telecardiology may be a safe alternative to routine inpatient examination.
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Affiliation(s)
- Bettina Nagy
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Ádám Pál-Jakab
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Boldizsár Kiss
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Gábor Orbán
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | | | - Zsigmond Dabasi-Halász
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Barbara Bernadett Móka
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - László Gellér
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, 1122 Budapest, Hungary
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Bertini M. Special Issue: "Biophysics, Arrhythmias and Pacing". BIOLOGY 2023; 12:biology12040569. [PMID: 37106769 PMCID: PMC10136281 DOI: 10.3390/biology12040569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
Cardiac pacing technologies have been implemented during the last few decades, including leadless pacemakers and pacing of the conduction system, such as His bundle pacing and left bundle branch area pacing [...].
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Affiliation(s)
- Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, 44124 Ferrara, Italy
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Sommers N, Berger M, Rubenstein JC, Roth J, Pan A, Thompson C, Widlansky ME. Onset of the COVID-19 pandemic reduced active time in patients with implanted cardiac devices. Eur Rev Aging Phys Act 2022; 19:26. [PMID: 36324065 PMCID: PMC9628136 DOI: 10.1186/s11556-022-00305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Physical inactivity and sedentary behavior are modifiable risk factors for chronic disease and all-cause mortality that may have been negatively impacted by the COVID-19 shutdowns. METHODS Accelerometry data was retrospectively collected from 332 permanent pacemaker (PPM) and 244 implantable cardiac defibrillation (ICD) patients for 6 time points: March 15-May 15, 2020 (pandemic period), January 1-March 14, 2020, October 1-December 31, 2019, March 15-May 15, 2019, January 1-March 14, 2019, and October 1-December 31, 2018. Paired t-tests, with Bonferroni correction, were used to compare time periods. RESULTS Activity significantly decreased during the pandemic period compared to one year prior by an average of 0.53 ± 1.18h/day (P < 0.001) for PPM patients and 0.51 ± 1.2h/day (P < 0.001) for ICD patients. Stratification of subjects by active time (< 2 versus ≥ 2h/day) showed patients with < 2h, particularly those with ICDs, had modestly greater activity reductions with the pandemic onset. Logistical regression analyses suggest a trend toward a greater reduction in active time at the onset of the pandemic and an increased risk of hospital or emergency department (ED) admission for PPM patients, but not ICD patients. CONCLUSION The onset of the pandemic in the United States was associated with a significant drop in PPM and ICD patient active hours that was modestly more pronounced in less active patients and cannot be explained by one year of aging or seasonal variation. If sustained, these populations may experience excess cardiovascular morbidity.
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Affiliation(s)
- Nicholas Sommers
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Marcie Berger
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Jason C. Rubenstein
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - James Roth
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Amy Pan
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Colton Thompson
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Michael E. Widlansky
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA ,grid.30760.320000 0001 2111 8460Division of Cardiovascular Medicine,, Medical College of Wisconsin, Milwaukee, WI USA
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Feijen M, Egorova AD, Treskes RW, Mertens BJA, Jukema JW, Schalij MJ, Beeres SLMA. Performance of a HeartLogicTM Based Care Path in the Management of a Real-World Chronic Heart Failure Population. Front Cardiovasc Med 2022; 9:883873. [PMID: 35600477 PMCID: PMC9120607 DOI: 10.3389/fcvm.2022.883873] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/30/2022] [Indexed: 01/11/2023] Open
Abstract
AimEarly detection of impending fluid retention and timely adjustment of (medical) therapy can prevent heart failure related hospitalizations. The multisensory cardiac implantable electronic device (CIED) based algorithm HeartLogicTM aims to alert in case of impending fluid retention. The aim of the current analysis is to evaluate the performance of the HeartLogicTM guided heart failure care path in a real-world heart failure population and to investigate whether the height of the index and the duration of the alert state are indicative of the degree of fluid retention.MethodsConsecutive adult heart failure patients with a CIED and an activated HeartLogicTM algorithm were eligible for inclusion. Patients were followed up according to the hospital's heart failure care path. The device technician reviewed alerts for a technical CIED checkup. Afterwards, the heart failure nurse contacted the patient to identify impending fluid retention. An alert was either true positive or false positive. Without an alert a patient was true negative or false negative.ResultsAmong 107 patients, [82 male, 70 (IQR 60–77) years, left ventricular ejection fraction 37 ± 11%] 130 HeartLogicTM alerts were available for analysis. Median follow up was 14 months [IQR 8–23]. The sensitivity to detect impending fluid retention was 79%, the specificity 88%. The positive predictive was value 71% and the negative predictive value 91%. The unexplained alert rate was 0.23 alerts/patient year and the false negative rate 0.17 alerts/patient year. True positive alerts [42 days (IQR 28–63)] lasted longer than false positive alerts [28 days (IQR 21–44)], p = 0.02. The maximal HeartLogicTM index was higher in true positive alerts [26 (IQR 21–34)] compared to false positive alerts [19 (IQR 17–24)], p < 0.01. Patients with higher HeartLogicTM indexes required more intense treatment (index height in outpatient setting 25 [IQR 20–32], day clinic treatment 28 [IQR 24–36] and hospitalized patients 45 [IQR 35–58], respectively), p < 0.01.ConclusionThe CIED-based HeartLogicTM algorithm facilitates early detection of impending fluid retention and thereby enables clinical action to prevent this at early stage. The current analysis illustrates that higher and persistent alerts are indicative for true positive alerts and higher index values are indicative for more severe fluid retention.
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Affiliation(s)
- Michelle Feijen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Roderick W. Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart J. A. Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Saskia L. M. A. Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Saskia L. M. A. Beeres
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