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Tay JCK, Lim ETS, Wong TJ, Feng JJ, Ching CK, Tan BY. Right bundle branch activation during left bundle branch pacing: Marginal gains in left bundle branch pacing-optimized cardiac resynchronization therapy and the effects of atrioventricular delay dynamic optimization. HeartRhythm Case Rep 2024; 10:191-197. [PMID: 38496735 PMCID: PMC10943543 DOI: 10.1016/j.hrcr.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
| | | | | | | | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Boon Yew Tan
- Prime Heart Centre, Gleneagles Hospital, Singapore
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Tay JCK, Lim ETS, Sim EYS, Chua KCM, Teo HK, Lim PCY, Chong DTT, Ho KL, Ching CK, Tan BY. Initial Experience of Left Bundle Branch Pacing using the Abbott Agilis HisPro Catheter with stylet-driven leads. Pacing Clin Electrophysiol 2022; 45:666-673. [PMID: 35417608 DOI: 10.1111/pace.14505] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
AIMS Conduction system pacing has gained steady interest over recent years. While the majority of tools and delivery techniques were developed for His bundle pacing (HBP), the feasibility and reproducibility of using these similar tools for left bundle branch pacing (LBBP) has yet to be determined. We describe our technique for performing LBBP using the Abbott Agilis HisProTM Steerable Catheter. METHODS AND RESULTS A series of 22 patients with a mean age of 71.7 years (16 males, 72.7%), underwent LBBP procedure with this catheter between May and October 2021. Nineteen patients (86%) had successful LBBP lead implantation. There were no major complications or mortality. CONCLUSION The Agilis HisProTM catheter along with the stylet driven Tendril STS Model 2088TC lead is a safe and feasible delivery system for LBBP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | - Hooi Khee Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Paul Chun Yih Lim
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | | | - Kah Leng Ho
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Boon Yew Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
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Shen X, Lee JSW, Tan BYQ, Dalakoti M, Sia CH, Yeo TJ, Wang L, Tan BY, Lim PCY, Chua KCM, Ho KL, Lim ETS, Ching CK, Teo WS, Chong DTT. 4286Population based prevalence of Brugada syndrome in a young male population in southeast asia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Shen
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - J S W Lee
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - B Y Q Tan
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - T J Yeo
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - L Wang
- Singapore Armed Forces Medical Corps, HQ Medical Corps, Singapore, Singapore
| | - B Y Tan
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - P C Y Lim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K C M Chua
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K L Ho
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - E T S Lim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - C K Ching
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - W S Teo
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
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Lim PCY, Lee ASY, Chua KCM, Lim ETS, Chong DTT, Tan BY, Ho KL, Teo WS, Ching CK. Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study. Singapore Med J 2017; 57:372-7. [PMID: 27439396 DOI: 10.11622/smedj.2016120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network. METHODS Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians. RESULTS A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported. CONCLUSION Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.
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Affiliation(s)
- Paul Chun Yih Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | | | | | - Boon Yew Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wee Siong Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Look X, Li H, Ng M, Lim ETS, Pothiawala S, Tan KBK, Sewa DW, Shahidah N, Pek PP, Ong MEH. Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients. Am J Emerg Med 2017; 36:66-72. [PMID: 28698133 DOI: 10.1016/j.ajem.2017.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Targeted temperature management post-cardiac arrest is currently implemented using various methods, broadly categorized as internal and external. This study aimed to evaluate survival-to-hospital discharge and neurological outcomes (Glasgow-Pittsburgh Score) of post-cardiac arrest patients undergoing internal cooling verses external cooling. METHODOLOGY A randomized controlled trial of post-resuscitation cardiac arrest patients was conducted from October 2008-September 2014. Patients were randomized to either internal or external cooling methods. Historical controls were selected matched by age and gender. Analysis using SPSS version 21.0 presented descriptive statistics and frequencies while univariate logistic regression was done using R 3.1.3. RESULTS 23 patients were randomized to internal cooling and 22 patients to external cooling and 42 matched controls were selected. No significant difference was seen between internal and external cooling in terms of survival, neurological outcomes and complications. However in the internal cooling arm, there was lower risk of developing overcooling (p=0.01) and rebound hyperthermia (p=0.02). Compared to normothermia, internal cooling had higher survival (OR=3.36, 95% CI=(1.130, 10.412), and lower risk of developing cardiac arrhythmias (OR=0.18, 95% CI=(0.04, 0.63)). Subgroup analysis showed those with cardiac cause of arrest (OR=4.29, 95% CI=(1.26, 15.80)) and sustained ROSC (OR=5.50, 95% CI=(1.64, 20.39)) had better survival with internal cooling compared to normothermia. Cooling curves showed tighter temperature control for internal compared to external cooling. CONCLUSION Internal cooling showed tighter temperature control compared to external cooling. Internal cooling can potentially provide better survival-to-hospital discharge outcomes and reduce cardiac arrhythmia complications in carefully selected patients as compared to normothermia.
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Affiliation(s)
| | - Huihua Li
- Division of Research, Singapore General Hospital, Singapore
| | - Mingwei Ng
- Emergency Medicine Residency, Singapore Health Services, Singapore
| | | | - Sohil Pothiawala
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Duu Wen Sewa
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore.
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Lim ETS, Wong ASL, Ahmad NSB, Tan KBK, Ong MEH, Tan JWC. Review of the Clinical Evidence and Controversies in Therapeutic Hypothermia for Survivors of Sudden Cardiac Death. Proceedings of Singapore Healthcare 2015. [DOI: 10.1177/201010581502400107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sudden cardiac arrest constitutes a major public health burden in both developed and developing countries. In those successfully resuscitated from cardiac arrest, subsequent mortality is still high (∼75%) and is due to a combination of ischaemia and reperfusion injury. The purpose of this review is to describe the experimental and clinical evidence supporting therapeutic hypothermia in survivors of sudden cardiac arrest. We also discuss controversies and unresolved issues in therapeutic hypothermia, including the optimum target temperature for therapeutic hypothermia, and the role of pre-hospital induction of hypothermia. We conclude with a perspective on therapeutic hypothermia as it applies to the Singapore context.
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Affiliation(s)
| | - Aaron Sung Lung Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | | | | | - Marcus Eng Hock Ong
- Duke-NUS Graduate Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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