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Fabbricatore D, Heggermont W, Buytaert D, Van Bockstal K, De Potter T. Arrhythmic Storm Due to ICD Atrial Lead Malfunction. JACC Case Rep 2022; 4:438-442. [PMID: 35693896 PMCID: PMC9175138 DOI: 10.1016/j.jaccas.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
We describe the case of a young woman with a dual-chamber implantable cardioverter-defibrillator for long-QT syndrome who was referred to our emergency department (Cardiovascular Research Centre of Aalst, Belgium) because of an “arrhythmic storm” caused by atrial lead fracture. This case highlights the importance of the correct choice of both the device type and the pacing modality. (Level of Difficulty: Intermediate.)
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Abstract
HEARTLOGICTM READY FOR PRIME TIME?
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Affiliation(s)
- Ward A Heggermont
- Onze Lieve Vrouw Hospital, Hartcentrum Aalst, Moorselbaan 164, B-9300 Aalst, Belgium.,Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 40, AZ-6202 Maastricht, The Netherlands
| | - Koen Van Bockstal
- Onze Lieve Vrouw Hospital, Hartcentrum Aalst, Moorselbaan 164, B-9300 Aalst, Belgium
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Heggermont W, Iliodromitis K, Van Bockstal K, Backers J, Lau CW, Missiaen D, De Cooman J, Timmermans W, Geelen P, De Potter T. Clinical symptoms of limited exercise capacity linked to AAI-DDD functionality: An in silico and in vivo approach. Pacing Clin Electrophysiol 2021; 44:943-951. [PMID: 33829506 DOI: 10.1111/pace.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/13/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exercise capacity is an important aspect of quality of life in patients undergoing pacemaker implantation. Device algorithms for ventricular pacing avoidance have been developed to avoid unnecessary and potentially harmful effects of right ventricular pacing. However, little data exists on the immediate response of these algorithms to sudden AV block during exercise. METHODS The ventricular pacing avoidance algorithms of four pacemaker manufacturers were tested in an ex-vivo model. The RSIM-1500-USB Device-Interactive Heart Simulator (Rivertek Medical Systems, Inc.) was used to simulate three different scenarios: the first one starting with an initially conducted atrial pacing rate of 60 min-1 , the second one starting with an atrial rate of 120 min-1 and finally a scenario starting with an atrial rate of 150 min-1 . In all three scenarios, the initially conducted atrial rate was followed by a sudden, long lasting episode of third-degree AV-block. The response to those scenarios was recorded for each of the (brand-specific) ventricular pacing avoidance algorithms. RESULTS In the first scenario, the simulation resulted in a ventricular pause of 1333 ms (Boston Scientific), 2000 ms (Medtronic and Microport), and 2340 ms (Biotronik). In the second and third scenario, different results were observed across devices. All simulations of the second and third scenario resulted in repetitive 2:1 block response (during eight cycles) in Boston Scientific and Biotronik devices. These scenarios were confirmed in patient cases. CONCLUSION Simulator based observations of unanticipated pacemaker-induced 2:1 block response during exercise may explain clinical symptoms experienced by some patients having a two-chamber pacemaker.
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Affiliation(s)
- Ward Heggermont
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium.,Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, Maastricht, AZ-6202, The Netherlands
| | - Konstantinos Iliodromitis
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Koen Van Bockstal
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Jos Backers
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Chirik-Wah Lau
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Dieter Missiaen
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Jan De Cooman
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Willy Timmermans
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Peter Geelen
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Tom De Potter
- Cardiovascular Research Center, Onze-Lieve-Vrouw Hospital Aalst, Moorselbaan 164, Aalst, B-9300, Belgium
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Treskes RW, Beles M, Caputo ML, Cordon A, Biundo E, Maes E, Egorova AD, Schalij MJ, Van Bockstal K, Grazioli-Gauthier L, Vanderheyden M, Bartunek J, Auricchio A, Beeres SLMA, Heggermont WA. Clinical and economic impact of HeartLogic™ compared with standard care in heart failure patients. ESC Heart Fail 2021; 8:1541-1551. [PMID: 33619901 PMCID: PMC8006675 DOI: 10.1002/ehf2.13252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 02/01/2023] Open
Abstract
Aims The implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator‐based HeartLogic™ algorithm has recently been developed for early detection of impending decompensation in heart failure (HF) patients; but whether this novel algorithm can reduce HF hospitalizations has not been evaluated. We investigated if activation of the HeartLogic algorithm reduces the number of hospital admissions for decompensated HF in a 1 year post‐activation period as compared with a 1 year pre‐activation period. Methods and results Heart failure patients with an implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator with the ability to activate HeartLogic and willingness to have remote device monitoring were included in this multicentre non‐blinded single‐arm trial with historical comparison. After a HeartLogic alert, the presence of HF symptoms and signs was evaluated. If there were two or more symptoms and signs apart from the HeartLogic alert, lifestyle advices were given and/or medication was adjusted. After activation of the algorithm, patients were followed for 1 year. HF events occurring in the 1 year prior to activation and in the 1 year after activation were compared. Of the 74 eligible patients (67.2 ± 10.3 years, 84% male), 68 patients completed the 1 year follow‐up period. The total number of HF hospitalizations reduced from 27 in the pre‐activation period to 7 in the post‐activation period (P = 0.003). The number of patients hospitalized for HF declined from 21 to 7 (P = 0.005), and the hospitalization length of stay diminished from average 16 to 7 days (P = 0.079). Subgroup analysis showed similar results (P = 0.888) for patients receiving cardiac resynchronization therapy during the pre‐activation period or not receiving cardiac resynchronization therapy, meaning that the effect of hospitalizations cannot solely be attributed to reverse remodelling. Subanalysis of a single‐centre Belgian subpopulation showed important reductions in overall health economic costs (P = 0.025). Conclusion Activation of the HeartLogic algorithm enables remote monitoring of HF patients, coincides with a significant reduction in hospitalizations for decompensated HF, and results in health economic benefits.
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Affiliation(s)
- Roderick W Treskes
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monika Beles
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Maria-Luce Caputo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Audrey Cordon
- Deloitte HEOR (Health Economics and Outcomes Research), Zaventem, Belgium
| | - Eliana Biundo
- Deloitte HEOR (Health Economics and Outcomes Research), Zaventem, Belgium
| | - Edith Maes
- Deloitte HEOR (Health Economics and Outcomes Research), Zaventem, Belgium
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen Van Bockstal
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | | | - Marc Vanderheyden
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Jozef Bartunek
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ward A Heggermont
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
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