1
|
Mundisugih J, Munawar DA, Mahajan R. The Necessary Perils of Pacemaker Implantation in Young Individuals-Can We Do Better? Heart Lung Circ 2022; 31:913-915. [PMID: 35752455 DOI: 10.1016/j.hlc.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Juan Mundisugih
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Dian A Munawar
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rajiv Mahajan
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
| |
Collapse
|
2
|
Shirwaiker A, William J, Mariani JA, Kistler PM, Patel HC, Voskoboinik A. Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience. Heart Lung Circ 2022; 31:993-998. [PMID: 35219598 DOI: 10.1016/j.hlc.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The long-term implications of pacemaker insertion in younger adults are poorly described in the literature. METHODS We performed a retrospective analysis of consecutive younger adult patients (18-50 yrs) undergoing pacemaker implantation at a quaternary hospital between 1986-2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed. RESULTS Eighty-one (81) patients (median age 41.0 yrs IQR=35-47.0, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.9 (IQR=1.1-14.9) years follow-up, nine patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation [n=11], device infection [n=1] and pocket revision [n=1]). Five (5) of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further nine patients (11%) experienced pacemaker-related morbidity from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in two patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and seven of these patients required subsequent biventricular upgrade. Furthermore, four patients (5%) developed new tricuspid regurgitation (>moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients. CONCLUSIONS Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
Collapse
Affiliation(s)
| | | | - Justin A Mariani
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Peter M Kistler
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | - Hitesh C Patel
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia.
| |
Collapse
|
3
|
Long-Term, Single-Centre Observation of Patients with Cardiac Implantable Electronic Devices. Medicina (B Aires) 2021; 57:medicina57121357. [PMID: 34946302 PMCID: PMC8704658 DOI: 10.3390/medicina57121357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 01/30/2023] Open
Abstract
Background and Objectives: Electrotherapy is a valuable treatment method for patients with heart rhythm disturbances. There are very few observations of long-term patients treated with these techniques. There is a particular lack of this type of study conducted in Eastern European countries. The aim of this single-centre analysis was to evaluate the long-term survival (from 2010 to 2018) of patients treated with electrotherapy devices, taking into account clinical factors facilitating the prognosis of these patients. Materials and Methods: The patients (N = 2071) subsequently included in the study were subjected to the implementation or replacement of cardiac pacemakers. The medical records of all the patients were analysed. Data concerning death, made available by the State Systems Department of the Ministry of Administration and Digitization, were used. Results: The patients with VVI pacemakers had the worst prognosis after the replacement of the devices. Male patients had a worse prognosis, regardless of the kind of device implanted. Advanced atrioventricular conduction disturbances, chronic kidney disease, and hypothyroidism with reduced left ventricular ejection fraction were among the most significant coexisting diseases. Conclusions: The long-term prognosis of patients under different forms of electrotherapy remains poor. Despite the more straightforward technique, a single-chamber device (VVI/AAI) or generator replacement leads to the worst prognosis. The complexity of the clinical picture that stems from coexisting diseases and advanced age is of the utmost importance.
Collapse
|
4
|
Echocardiographic Predictors of All-Cause Mortality in Patients with Hypertrophic Cardiomyopathy following Pacemaker Implantation. Cardiol Res Pract 2020; 2020:2923767. [PMID: 32148950 PMCID: PMC7042507 DOI: 10.1155/2020/2923767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives To examine the association between the echocardiographic parameters measured as left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) and long-term risk of all-cause mortality in adults with hypertrophic cardiomyopathy (HCM) following pacemaker implantation. Methods A total of 94 adult patients with HCM who underwent pacemaker implantation from November 2002 to June 2013 in our Arrhythmia Center for symptomatic bradycardia and did not receive an implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT) during follow-up were retrospectively extracted. Results After careful examination of the medical records, we retrospectively evaluated the clinical characteristics of 74 patients with LAD records (58.1 ± 14.9 years) and 76 patients with LVEDD records (57.6 ± 15.2 years). Based on the receiver-operating characteristic (ROC) curve, the values of LAD = 44 mm and LVEDD = 43 mm were identified to predict the all-cause mortality. In the Kaplan–Meier survival, LAD ≥44 mm and LVEDD ≥43 mm were both significantly associated with all-cause mortality (log-rank test P < 0.05). Cox regression analysis indicated that LAD ≥44 mm (HR 3.580; 95% CI = 1.055–12.148; P=0.041) was an independent predictor of all-cause mortality, while LVEDD ≥43 mm was not significantly associated with all-cause mortality. LVOTO was also significantly associated with all-cause mortality (HR = 0.166; 95% CI = 0.036–0.771; P=0.022). Conclusions In HCM patients with pacemaker implantation, LAD ≥44 mm was an independent predictor of all-cause mortality.
Collapse
|