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Schvartz N, Haidary A, Wakili R, Hecker F, Kupusovic J, Zsigmond EJ, Miklos M, Saghy L, Szili-Torok T, Erath JW, Vamos M. Risk of Cardiac Implantable Electronic Device Infection after Early versus Delayed Lead Repositioning. J Cardiovasc Dev Dis 2024; 11:117. [PMID: 38667735 PMCID: PMC11049932 DOI: 10.3390/jcdd11040117] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Early reintervention increases the risk of infection of cardiac implantable electronic devices (CIEDs). Some operators therefore delay lead repositioning in the case of dislocation by weeks; however, there is no evidence to support this practice. The aim of our study was to evaluate the impact of the timing of reoperation on infection risk. (2) Methods: The data from consecutive patients undergoing lead repositioning in two European referral centers were retrospectively analyzed. The odds ratio (OR) of CIED infection in the first year was compared among patients undergoing early (≤1 week) vs. delayed (>1 week to 1 year) reoperation. (3) Results: Out of 249 patients requiring CIED reintervention, 85 patients (34%) underwent an early (median 2 days) and 164 (66%) underwent a delayed lead revision (median 53 days). A total of nine (3.6%) wound/device infections were identified. The risk of infection was numerically lower in the early (1.2%) vs. delayed (4.9%) intervention group yielding no statistically significant difference, even after adjustment for typical risk factors for CIED infection (adjusted OR = 0.264, 95% CI 0.032-2.179, p = 0.216). System explantation/extraction was necessary in seven cases, all being revised in the delayed group. (4) Conclusions: In this bicentric, international study, delayed lead repositioning did not reduce the risk of CIED infection.
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Affiliation(s)
- Noemi Schvartz
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Arian Haidary
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Reza Wakili
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Florian Hecker
- Department of Cardiac Surgery, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Jana Kupusovic
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Elod-Janos Zsigmond
- Doctoral School of Clinical Medicine, University of Szeged, 6725 Szeged, Hungary
- Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Marton Miklos
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Laszlo Saghy
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Tamas Szili-Torok
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
| | - Julia W. Erath
- Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Mate Vamos
- Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary; (N.S.)
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Szonyi MD, Pap R, Vamos M. Use of mexiletine in therapy-refractory recurrent ventricular tachycardia storm. Herzschrittmacherther Elektrophysiol 2023; 34:326-329. [PMID: 37917362 DOI: 10.1007/s00399-023-00976-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Electrical storm due to recurrent ventricular tachycardias (VTs) is a life-threatening arrhythmic emergency. The authors present a case report of a 69-year-old male patient with VT storm of non-ischemic etiology. Despite optimal medical treatment escalated by amiodarone antiarrhythmic drug therapy, the patient experienced multiple implantable cardioverter defibrillator (ICD) shocks. An electrophysiological study revealed an epicardial substrate; however, considering the patient's extreme obesity and active anticoagulant effect, catheter ablation was deemed to be unfeasible. Subsequently, mexiletine was added to the patient's drug regimen, resulting in successful control of arrhythmias during the following 6 months. Although the most recent European guidelines for the management of patients with ventricular arrhythmias mention mexiletine only for the treatment of LQT3 patients, its use for treatment-refractory VT storm seems to also be an important indication area.
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Affiliation(s)
- Mihaly D Szonyi
- Gottsegen National Cardiovascular Center, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Robert Pap
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary.
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Simon A, Pilecky D, Kiss LZ, Vamos M. Useful Electrocardiographic Signs to Support the Prediction of Favorable Response to Cardiac Resynchronization Therapy. J Cardiovasc Dev Dis 2023; 10:425. [PMID: 37887872 PMCID: PMC10607456 DOI: 10.3390/jcdd10100425] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is a cornerstone therapeutic opportunity for selected patients with heart failure. For optimal patient selection, no other method has been proven to be more effective than the 12-lead ECG, and hence ECG characteristics are extensively researched. The evaluation of particular ECG signs before the implantation may improve selection and, consequently, clinical outcomes. The definition of a true left bundle branch block (LBBB) seems to be the best starting point with which to select patients for CRT. Although there are no universally accepted definitions of LBBB, using the classical LBBB criteria, some ECG parameters are associated with CRT response. In patients with non-true LBBB or non-LBBB, further ECG predictors of response and non-response could be analyzed, such as QRS fractionation, signs of residual left bundle branch conduction, S-waves in V6, intrinsicoid deflection, or non-invasive estimates of Q-LV which are described in newer publications. The most important and recent study results of the topic are summarized and discussed in this current review.
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Affiliation(s)
- Andras Simon
- Department of Cardiology, Szent Imre University Teaching Hospital, 1115 Budapest, Hungary;
| | - David Pilecky
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6725 Szeged, Hungary
| | | | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
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Debreceni D, Janosi K, Bocz B, Turcsan M, Lukacs R, Simor T, Antolič B, Vamos M, Komocsi A, Kupo P. Zero fluoroscopy catheter ablation for atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1178783. [PMID: 37396578 PMCID: PMC10313423 DOI: 10.3389/fcvm.2023.1178783] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Catheter ablation for atrial fibrillation (AF) is the most frequently performed cardiac ablation procedure worldwide. The majority of ablations can now be performed safely with minimal radiation exposure or even without the use of fluoroscopy, thanks to advances in 3-dimensional electroanatomical mapping systems and/or intracardiac echocardiography. The aim of this study was to conduct a meta-analysis to compare the effectiveness of zero fluoroscopy (ZF) versus non-zero fluoroscopy (NZF) strategies for AF ablation procedures. Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of ZF vs. NZF approaches in patients undergoing catheter ablation for AF. We used a random-effects model to derive the mean difference (MD) and risk ratios (RR) with a 95% confidence interval (CI). Results Our meta-analysis included seven studies comprising 1,593 patients. The ZF approach was found to be feasible in 95.1% of patients. Compared to the NZF approach, the ZF approach significantly reduced procedure time [mean difference (MD): -9.11 min (95% CI: -12.93 to -5.30 min; p < 0.01)], fluoroscopy time [MD: -5.21 min (95% CI: -5.51 to -4.91 min; p < 0.01)], and fluoroscopy dose [MD: -3.96 mGy (95% CI: -4.27 to -3.64; p < 0.01)]. However, there was no significant difference between the two groups in terms of total ablation time [MD: -104.26 s (95% CI: -183.37 to -25.14; p = 0.12)]. Furthermore, there was no significant difference in the acute [risk ratio (RR): 1.01, 95% CI: 1.00-1.02; p = 0.72] and long-term success rates (RR: 0.96, 95% CI: 0.90-1.03; p = 0.56) between the ZF and NZF methods. The complication rate was 2.76% in the entire study population and did not differ between the groups (RR: 0.94, 95% CI: 0.41-2.15; p = 0.89). Conclusion The ZF approach is a feasible method for AF ablation procedures. It significantly reduces procedure time and radiation exposure without compromising the acute and long-term success rates or complication rates.
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Affiliation(s)
| | - Kristof Janosi
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Botond Bocz
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Marton Turcsan
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Reka Lukacs
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Simor
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Bor Antolič
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andras Komocsi
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
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Vamos M, Zsigmond EJ, Hohnloser SH. Indications for mexiletine in the new ESC guidelines and beyond. Expert Opin Pharmacother 2023; 24:1403-1407. [PMID: 37306465 DOI: 10.1080/14656566.2023.2223964] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Mexiletine is a class IB sodium-channel blocker. Unlike class IA or IC antiarrhythmic drugs, mexiletine rather shortens than prolongs action potential duration; therefore, it is less associated with proarrhythmic effects. AREAS COVERED Recently, new European Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death were published, including a reappraisal of some established older antiarrhythmic drugs. EXPERT OPINION Mexiletine offers a first-line, genotype-specific treatment strategy for LQT3 patients as emphasized by the most recent guidelines. Besides this recommendation, current study reports suggest that in therapy-refractory ventricular tachyarrhythmias and electrical storms adjunctive mexiletine treatment may offer the possibility of stabilizing patients with or without concomitant interventional therapy such as catheter ablation.
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Affiliation(s)
- Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Elod-Janos Zsigmond
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Stefan H Hohnloser
- Department of Cardiology, J. W. Goethe University, Frankfurt Am Main, Germany
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Kupo P, Riesz TJ, Saghy L, Vamos M, Bencsik G, Makai A, Kohari M, Benak A, Miklos M, Pap R. Ultrasound guidance for femoral venous access in patients undergoing pulmonary vein isolation: a quasi-randomized study. J Cardiovasc Electrophysiol 2023; 34:1177-1182. [PMID: 36942777 DOI: 10.1111/jce.15893] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 01/04/2023] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Routine ultrasound (US)-guidance for femoral venous access to decrease vascular complications of atrial fibrillation (AF) ablation procedures has been advocated. However, the benefit has not been unequivocally demonstrated by randomized-trial data. METHODS AND RESULTS Consecutive patients undergoing pulmonary vein isolation (PVI) on uninterrupted anticoagulant treatment were included. A quasi-random allocation to either US-guided or conventional puncture group was based on which of the two procedure rooms the patient was scheduled in, with only one of the rooms equipped with an US machine including a vascular transducer. The same 4 novice operators in rotation, with no relevant previous experience in US-guided vascular access performed venous punctures in both rooms. Major and minor vascular complications and the rate of prolonged hospitalization were compared. Major vascular complication was defined as groin hematoma, arteriovenous fistula, or pseudoaneurysm. Hematoma was considered as a major vascular complication if it met type 2 or higher Bleeding Academic Research Consortium criteria (requiring nonsurgical, medical intervention by a health care professional; leading to hospitalization or increased level of care, or prompting evacuation). Of the 457 patients 199 were allocated to the US-guided puncture group, while the conventional, palpation-based approach was performed in 258 cases. Compared to the conventional technique, US-guidance reduced the rate of any vascular complication (11.63% vs. 2.01%, p<0.0001), including both major (4.26% vs. 1.01%, p=0.038) and minor (7.36% vs 1.01%, p=0.001) vascular complications. In addition, the rate of prolonged hospitalization was lower in the US-guided puncture group (5.04% vs. 1.01%, p=0.032). CONCLUSION The use of US for femoral vein puncture in patients undergoing PVI decreased the rate of both major and minor vascular complications. This quasi-randomized comparison strongly supports adapting routine use of US for AF ablation procedures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Kupo
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Janos Riesz
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Laszlo Saghy
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Mate Vamos
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Gabor Bencsik
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Attila Makai
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Maria Kohari
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Attila Benak
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Marton Miklos
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
| | - Robert Pap
- University of Szeged, Department of Internal Medicine, Medical School, University of Szeged, Szeged, Hungary
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Vamos M, Erath JW, Benz AP, Duray GZ. Editorial: Developments in cardiac implantable electronic device therapy: how can we improve clinical implementation? Front Cardiovasc Med 2023; 10:1177882. [PMID: 37153463 PMCID: PMC10155095 DOI: 10.3389/fcvm.2023.1177882] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
CIED, cardiac implantable electronic devices; CRT, cardiac resynchronization therapy; CRT-D, cardiac resynchronization therapy defibrillator; EA, electroanatomical; ICD, implantable cardioverter defibrillator; LBB, left bundle branch; LBBAP, left bundle branch area pacing; LV, left ventricular; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; MRI, cardiac magnetic resonance imaging; S-ICD, subcutaneous defibrillator.
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Affiliation(s)
- Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
- Correspondence: Mate Vamos ;
| | - Julia W. Erath
- Dep. of Cardiology, University Hospital Frankfurt—Goethe University, Frankfurt am Main, Germany
| | - Alexander P. Benz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Gabor Z. Duray
- Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
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Vamos M, Saghy L, Jankelson L, Garber L, Pap R. Inability to perform 'en bloc' pulmonary vein isolation requiring ablation of the intervenous carina increases recurrence of atrial fibrillation: A meta-analysis. Pacing Clin Electrophysiol 2022; 45:1415-1418. [PMID: 36272168 DOI: 10.1111/pace.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Failure to isolate ipsilateral pulmonary veins (PV) "en bloc" by wide-area circumferential ablation (WACA) may necessitate ablation at the intervenous carina. It is unknown how this scenario impacts rates of atrial fibrillation (AF) recurrence. METHODS A standard random-effect meta-analysis of randomized or observational studies were performed, where the outcome of first-time AF ablation was reported in patients with "en bloc" isolation of PVs by WACA as compared with those in whom ablation at the intervenous carina was needed after WACA to achieve complete isolation. RESULTS A total of five single-center, observational studies (N = 1185) and one, multi-center randomized trial (N = 234) were enrolled. PV isolation could be achieved by WACA "en bloc" in 902/1419 (63.6%) cases. The rest required additional ablation at one or both of the left and right intervenous carinas to achieve isolation. The follow-up time after ablation ranged from 1 to 2 years in the included trials. The incidence of AF recurrence proved to be significantly lower in patients with successful "en bloc" isolation compared to those requiring carina ablation(s) to achieve complete bilateral PV isolation (MH-OR 1.89, 95% CI 1.42-2.53, p < .01) CONCLUSION: This present meta-analysis demonstrates a lower arrhythmia recurrence rate in patients with bilateral "en bloc" isolation, as compared to those who needed additional carina ablation for complete PVI. Therefore, it is imperative that every effort be made to isolate ipsilateral PVs "en bloc" during PVI.
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Affiliation(s)
- Mate Vamos
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Szeged, Hungary
| | - Laszlo Saghy
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Szeged, Hungary
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Leonid Garber
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Robert Pap
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Szeged, Hungary
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Zsigmond EJ, Saghy L, Benak A, Miklos M, Makai A, Hegedus Z, Alacs E, Agocs S, Vamos M. A head-to-head comparison of laser vs. powered mechanical sheaths as first choice and second line extraction tools. Europace 2022; 25:591-599. [PMID: 36352816 PMCID: PMC9935030 DOI: 10.1093/europace/euac200] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. This study aimed to compare outcomes with the laser and powered mechanical tools. METHODS AND RESULTS Single-centre data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analysed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analysed. Moreover, we examined the efficacy of each level of the stepwise approach. Out of 166 patients, 142 (age 65.4 ± 13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4 ± 6.3 years). Laser sheaths were used in 64.9%, powered mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (P = 0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in the case of three patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (P = 0.187). Among crossover procedures, only clinical success favoured the secondary mechanical arm (87.1 vs. 54.5%, aOR: 0.09, 95% CI: 0.01-0.79, P = 0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery. CONCLUSION The efficacy and safety of laser and mechanical sheaths were similar, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to help improving outcomes, especially in the most complicated cases.
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Affiliation(s)
- Elod-Janos Zsigmond
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Laszlo Saghy
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Attila Benak
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Marton Miklos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Attila Makai
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Zoltan Hegedus
- Heart Surgery Department, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary
| | - Endre Alacs
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis str. 6, 6725 Szeged, Hungary
| | - Szilvia Agocs
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis str. 6, 6725 Szeged, Hungary
| | - Mate Vamos
- Corresponding author. Tel: +36 62 341 559; Fax: +36 62 342 538, E-mails address: ;
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Kattih B, Operhalski F, Boeckling F, Hecker F, Michael F, Vamos M, Hohnloser SH, Erath JW. Clinical outcomes of subcutaneous vs. transvenous implantable defibrillator therapy in a polymorbid patient cohort. Front Cardiovasc Med 2022; 9:1008311. [PMID: 36330004 PMCID: PMC9624387 DOI: 10.3389/fcvm.2022.1008311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) has been designed to overcome lead-related complications and device endocarditis. Lacking the ability for pacing or resynchronization therapy its usage is limited to selected patients at risk for sudden cardiac death (SCD). Objective The aim of this single-center study was to assess clinical outcomes of S-ICD and single-chamber transvenous (TV)-ICD in an all-comers population. Methods The study cohort comprised a total of 119 ICD patients who underwent either S-ICD (n = 35) or TV-ICD (n = 84) implantation at the University Hospital Frankfurt from 2009 to 2017. By applying an inverse probability-weighting (IPW) analysis based on the propensity score including the Charlson Comorbidity Index (CCI) to adjust for potential extracardiac comorbidities, we aimed for head-to-head comparison on the study composite endpoint: overall survival, hospitalization, and device-associated events (including appropriate and inappropriate shocks or system-related complications). Results The median age of the study population was 66.0 years, 22.7% of the patients were female. The underlying heart disease was ischemic cardiomyopathy (61.4%) with a median LVEF of 30%. Only 52.9% had received an ICD for primary prevention, most of the patients (67.3%) had advanced heart failure (NYHA class II–III) and 16.8% were in atrial fibrillation. CCI was 5 points in TV-ICD patients vs. 4 points for patients with S-ICD (p = 0.209) indicating increased morbidity. The composite endpoint occurred in 38 patients (31.9 %), revealing no significant difference between patients implanted with an S-ICD or TV-ICD (unweighted HR 1.50, 95 % confidence interval (CI) 0.78–2.90; p = 0.229, weighted HR 0.94, 95% CI, 0.61–1.50, p = 0.777). Furthermore, we observed no difference in any single clinical endpoint or device-associated outcome, neither in the unweighted cohort nor following inverse probability-weighting. Conclusion Clinical outcomes of the S-ICD and TV-ICD revealed no differences in the composite endpoint including survival, freedom of hospitalization and device-associated events, even after careful adjustment for potential confounders. Moreover, the CCI was evaluated in a S-ICD cohort demonstrating higher survival rates than predicted by the CCI in young, polymorbid (S-)ICD patients.
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Affiliation(s)
- Badder Kattih
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Felix Operhalski
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Felicitas Boeckling
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Florian Hecker
- Department of Cardiac Surgery, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Felix Michael
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Stefan H. Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Julia W. Erath
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
- *Correspondence: Julia W. Erath
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11
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Vamos M, Oldgren J, Nam GB, Lip GYH, Calkins H, Zhu J, Ueng KC, Ludwigs U, Wieloch M, Stewart J, Hohnloser SH. Dronedarone vs. placebo in patients with atrial fibrillation or atrial flutter across a range of renal function: a post hoc analysis of the ATHENA trial. European Heart Journal - Cardiovascular Pharmacotherapy 2022; 8:363-371. [PMID: 34958366 PMCID: PMC9175188 DOI: 10.1093/ehjcvp/pvab090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/03/2021] [Accepted: 12/22/2021] [Indexed: 12/04/2022]
Abstract
Aims Use of antiarrhythmic drugs (AADs) in patients with chronic kidney disease (CKD) is challenging owing to issues with renal clearance, drug accumulation, and increased proarrhythmic risks. Because CKD is a common comorbidity in patients with atrial fibrillation/atrial flutter (AF/AFL), it is important to establish the efficacy and safety of AAD treatment in patients with CKD. Methods and results Dronedarone efficacy and safety in individuals with AF/AFL and varying renal functionality [estimated glomerular filtration rate (eGFR): ≥60, ≥45 and <60, and <45 mL/min] was investigated in a post hoc analysis of ATHENA (NCT00174785), a randomized, double-blind trial of dronedarone vs. placebo in patients with paroxysmal or persistent AF/AFL plus additional cardiovascular (CV) risk factors. Log-rank testing and Cox regression were used to compare the incidence of endpoints between treatments. Overall, 4588 participants were enrolled from the trial. There was no interaction between treatment group and baseline eGFR assessed as a continuous variable (P = 0.743) for the first CV hospitalization or death from any cause (primary outcome). This outcome was lower with dronedarone vs. placebo across a wide range of renal function. First CV hospitalization and first AF/AFL recurrence were both lower in the two least renally impaired subgroups with dronedarone vs. placebo. Treatment emergent adverse events leading to treatment discontinuation were more frequent with dronedarone vs. placebo and occurred more often in patients with severe renal impairment. Conclusion Dronedarone is an effective AAD in patients with AF/AFL and CV risk factors across a wide range of renal function.
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Affiliation(s)
- Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Szeged , Hungary
| | - Jonas Oldgren
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University , Uppsala , Sweden
| | - Gi-Byoung Nam
- Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool , UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University , Baltimore, MD , USA
| | - Jun Zhu
- Fuwai Hospital, CAMS & PUMC , Beijing , China
| | - Kwo-Chang Ueng
- Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital , Taichung City , Taiwan
| | | | - Mattias Wieloch
- Sanofi , Paris , France
- Department of Clinical Sciences Malmö, Lund University , Malmö , Sweden
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12
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Vamos M, Zsigmond EJ, Benak A, Miklos M, Makai A, Hegedus Z, Alacs E, Agocs SZ, Saghy L. A head-to-head comparison of the first choice and crossover lead extraction tool: laser vs. mechanical. Europace 2022. [DOI: 10.1093/europace/euac053.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths.
Purpose
This study aimed to compare outcomes with the laser and mechanical tools.
Methods
Single-center data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analyzed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analyzed. Moreover, we examined the efficacy of each level of the stepwise approach.
Results
Out of 166 patients 142 (age 65.4±13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4±6.3 years). Laser sheaths were used in 64.9%, mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (p=0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in case of 3 patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (p=0.187). Among crossover procedures only clinical success favored the secondary mechanical arm (87.1% vs. 54.5%, aOR: 0.09, 95%CI: 0.01-0.79, p=0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery (Figure).
Conclusion
The efficacy and safety of laser and mechanical sheaths were similar in our study, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to be indispensable in order to achieve the most optimal outcomes.
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Affiliation(s)
- M Vamos
- University of Szeged, Szeged, Hungary
| | | | - A Benak
- University of Szeged, Szeged, Hungary
| | - M Miklos
- University of Szeged, Szeged, Hungary
| | - A Makai
- University of Szeged, Szeged, Hungary
| | - Z Hegedus
- University of Szeged, Szeged, Hungary
| | - E Alacs
- University of Szeged, Szeged, Hungary
| | - SZ Agocs
- University of Szeged, Szeged, Hungary
| | - L Saghy
- University of Szeged, Szeged, Hungary
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13
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Debreceni D, Janosi K, Vamos M, Komocsi A, Simor T, Kupo P. Zero and Minimal Fluoroscopic Approaches During Ablation of Supraventricular Tachycardias: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:856145. [PMID: 35479287 PMCID: PMC9037593 DOI: 10.3389/fcvm.2022.856145] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. To guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches have become available, using three-dimensional electroanatomical mapping systems. Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardia (SVT). Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing electrophysiology (EP) procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RRs) with 95% confidence interval (CI). Results Twenty-four studies involving 9,074 patients met our inclusion criteria. There was no difference between the groups in terms of acute success rate (RR = 1.00, 95% CI, 0.99–1.01; p = 0.97) and long-term success rate (RR: 1.01, 95% CI, 1.00–1.03; p = 0.13). Compared to the conventional method, zero-and-minimal fluoroscopy (Z/MF) ablation significantly reduced fluoroscopic time [MD: −1.58 min (95% CI, −2.21 to −0.96 min; p < 0.01)] and ablation time [MD: −25.23 s (95% CI: −42.04 to −8.43 s; p < 0.01)]. No difference could be detected between the two groups in terms of the procedure time [MD: 3.06 min (95% CI: −0.97 to 7.08; p = 0.14)] and the number of ablation applications [MD: 0.13 (95% CI: −0.86 to 1.11; p = 0.80)]. The complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95% CI: 0.45–1.05; p = 0.08). Conclusions The Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time without compromising the acute and long-term success or complication rates.
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Affiliation(s)
- Dorottya Debreceni
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
- *Correspondence: Dorottya Debreceni
| | - Kristof Janosi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andras Komocsi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Tamas Simor
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
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Vamos M, Saghy L, Bencsik G. Implantation of a VDD implantable cardioverter-defibrillator lead via a persistent left superior vena cava. Herzschrittmacherther Elektrophysiol 2022; 33:81-83. [PMID: 34989832 PMCID: PMC8873162 DOI: 10.1007/s00399-021-00835-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
A persistent left superior vena cava (LSVC) represents a challenging congenital abnormality for transvenous cardiac device implantation. In the current case a secondary prophylactic VDD implantable cardioverter-defibrillator (ICD) implantation was planned in a 75-year-old woman presenting with ischemic cardiomyopathy and elevated stroke risk. Since no venous communication to the right side was identified intraoperatively, the lead was placed via the persistent LSVC. The far-field signal on the floating atrial dipole could be successfully blanked out, and appropriate device function with high and stable atrial sensing was demonstrated at follow-up.
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Affiliation(s)
- Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary.
| | - Laszlo Saghy
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary
| | - Gabor Bencsik
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary
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15
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Vamos M, Nemeth M, Balazs T, Zima E, Duray GZ. Rationale and feasibility of the atrioventricular single-lead ICD systems with a floating atrial dipole (DX) in clinical practice. Trends Cardiovasc Med 2021; 32:84-89. [PMID: 33482321 DOI: 10.1016/j.tcm.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/30/2023]
Abstract
Cardiac implantable electronic devices establish proper therapy for the prevention of sudden cardiac death, significantly reducing the morbidity and mortality of patients with arrhythmias and heart failure. It is well-known that the number of electrodes increases the risk of complications. To preserve the benefit of atrial sensing without the need to implant an additional lead, a single-lead ICD system with a floating atrial dipole (DX ICD lead) has been developed. Besides all of the potential benefits, the necessity of a reliable and stable atrial sensing via the floating dipole could be the main concern against the use of this lead type. In the current generation of DX devices, the specially filtered atrial signal seems to be high enough and stable over time, which is crucial in the early detection of atrial arrhythmias, discrimination between different forms of tachycardias in order to prevent inappropriate ICD therapy, and achieving an optimal atrioventricular and interventricular synchrony in patients with a two-lead CRT-DX system. The present review summarizes the benefits and potential drawbacks of the DX ICD systems based on the available literature, furthermore, proposes an evidence-based algorithm of ICD type selection.
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Affiliation(s)
- Mate Vamos
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Semmelweis u. 8., 6725 Szeged, Szeged, Hungary.
| | | | | | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Medical Centre, Hungarian Defense Forces, Budapest, Hungary
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16
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Vamos M, Oldgren J, Nam GB, Lip G, Calkins H, Zhu J, Ueng KC, Ludwigs U, Wieloch M, Stewart J, Hohnloser S. Dronedarone vs placebo in patients with atrial fibrillation or atrial flutter across a range of renal function: a post hoc analysis of the ATHENA trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The use of antiarrhythmic drugs in patients with chronic kidney disease (CKD) is challenging due to issues with renal clearance, drug accumulation and increased proarrhythmic risks. Since CKD is a common comorbidity with atrial fibrillation (AF), it is important to establish the efficacy and safety for antiarrhythmic drug treatment in patients with CKD.
Purpose
To evaluate the efficacy and safety of dronedarone in patients with AF or atrial flutter (AFL) across different stages of renal impairment.
Methods
In this post-hoc analysis of ATHENA (NCT00174785), a randomised, double-blind trial of dronedarone 400 mg BID vs placebo in patients with AF or AFL plus additional risk factors for death and a calculated glomerular filtration rate ≥10 mL/min, the primary outcome was time to first cardiovascular (CV) hospitalisation or death. Renal function (estimated glomerular filtration rate [eGFR]) was assessed using CKD Epidemiology Collaboration equation and patients were grouped by eGFR (10–44, 45–59, ≥60 mL/min). Log-rank testing and Cox regression were used to compare time to events between treatment groups.
Results
In ATHENA, 43.6% of placebo and 42.2% of dronedarone patients had mild-to-moderate CKD (Table). Median time to CV hospitalisation/death was longer in all strata for dronedarone vs placebo, reaching significance in the 45–59 and ≥60 mL/min groups (Figure 1). There was a trend towards more treatment-emergent adverse events (TEAEs), deaths and discontinuations due to TEAEs in patients with eGFR 10–44 mL/min. No clear difference in safety was seen between treatment arms except for discontinuations, which were higher with dronedarone.
Conclusions
This analysis confirms the efficacy of dronedarone, demonstrated in ATHENA, across different stages of renal impairment. Further assessment of safety will require larger populations of patients with CKD.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Sanofi
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Affiliation(s)
- M Vamos
- University of Szeged, Szeged, Hungary
| | - J Oldgren
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala, Sweden
| | - G.-B Nam
- Asan Medical Center, Seoul, Korea (Republic of)
| | - G Lip
- University of Liverpool, Liverpool, United Kingdom
| | - H Calkins
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - J Zhu
- Fuwai Hospital, CAMS and PUMC, Beijing, China
| | - K.-C Ueng
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | | | | | - S.H Hohnloser
- J.W. Goethe University, Department of Cardiology, Frankfurt, Germany
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17
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Muk B, Vamos M, Vagany D, Majoros Z, Pilecky D, Juhasz I, Szogi E, Kosa K, Borsanyi T, Dekany M, Kiss R, Nyolczas N. The prevalence of RAASi uptitration limiting hyperkalemia and the suitability of potassium binders among patients suffering from heart failure with reduced ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of the renin-angiotensin-aldosteron-system inhibitor (RAASi) regime is crucial to reduce the mortality and morbidity of heart failure with reduced ejection fraction (HFrEF). However, it is well known that among real life circumstances it is challenging to reach the guideline-recommended target doses (TDs) of RAASi-s, due to the occurrence of side effects (e.g. hyperkalemia). Based on the ESC expert consensus document, it is recommended to reduce the RAASi dosages or discontinue the therapy when significant hyperkalemia (HK) occurs (serum potassium >5.0 mmol/l or >6.0 mmol/l, respectively). Within the last years, trials of patiromer and zirconium cyclosilicate demonstrated dose-dependent effect of these drugs enhancing potassium level lowering. The ongoing DIAMOND study examining the effect of patiromer among patients with previous HK (se potassium >5mmol/l) in the effect of RAASi-s in HFrEF hopefully will answer the question whether the use of a potassium binder and in its effect the use of TD-s of RAASi translates to significant mortality benefit in HFrEF.
Aim
To assess the prevalence of RAASi uptitration limiting HK and to assess the potential suitability of potassium binders among HFrEF patients followed-up regularly at a heart failure outpatient clinic (HFOC).
Methods
Data of 557 consecutive HFrEF patients (NYHA: 3.1±0.8; LVEF: 27.4±6.6%; age: 61.2±13.0 years; male: 76.3%; ischemic: 47.2%; atrial fibrillation: 27.3%; diabetes: 35.7%; hypertension: 72.7%, systolic blood pressure: 124.3±24.3mmHg, eGFR: 65.6±23.6 ml/min/1.73m2) was analyzed. At baseline ACEi/ARBs in 33.6%, BBs in 40.9%, MRAs in 37.9% of the total cohort (TC) were used.
Results
After therapy optimization (TO) ACEis/ARBs were applied in 97.5% and TD (equivalent to at least 10 mg of enalapril b.i.d.) was reached in 59.4% of the TC. BBs in 90.7%, TDs of BBs in 48.3%, MRAs in 64.3%, TDs of MRAs in 24.6% of the TC were applied. In 100 patients (17.9%) the TDs of ACEi/ARBs and MRAs were reached simultaneously. Among those 457 patients not reaching the TD of ACEi/ARBs and/or the TD of MRAs the occurrence of HK (se potassium >5 mmol/l) was quite frequent (45.3%, 207 patients), the prevalence of HK with the need of permanent dose reduction of RAASi regime (se potassium>5.5 mmol/l) was 10.5% (48 patients) and the prevalence of HK resulting permanent discontinuation of RAASi (se potassium >6.0 mmol/l) was 2.8% (13 patient) during the TO.
Conclusions
The current ESC guidelines recommend the use of TDs or maximal tolerated doses of RAASi-s in HFrEF. In a real-world patient cohort when every effort was made to reach the TDs, the TD of ACEi/ARBs and the TD of MRAs was reachable only in 17.9% of patients due the side effects observed during the TO. The occurrence of HK preventing to reach the TD, resulting down-titration or temporary/permanent discontinuation of RAASi-s and representing potential suitability for potassium binders is significant among optimally treated HFrEF patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Muk
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Vamos
- University of Szeged, 2nd Department of Medicine and Cardiology Center, Szeged, Hungary
| | - D Vagany
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - Z.S Majoros
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - D Pilecky
- Klinikum Passau, Department of Internal Medicine III, Passau, Germany
| | - I.Z.S Juhasz
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - E Szogi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - K Kosa
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - T Borsanyi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Dekany
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - R.G Kiss
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - N Nyolczas
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
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18
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Benak A, Kohari M, Besenyi Z, Makai A, Saghy L, Vamos M. Management of cardiac implantable electronic device infection using a complete interdisciplinary approach. Herzschrittmacherther Elektrophysiol 2020; 32:124-127. [PMID: 33095291 DOI: 10.1007/s00399-020-00728-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Technological advances and increasing operator experience have improved the success rate of transvenous lead extraction (TLE). However, in some cases-especially with longer lead dwelling time-TLE can be highly complicated. In this case report, the authors present an unusual case of implantable cardioverter defibrillator (ICD) pocket infection diagnosed by 18F‑fluorodeoxyglucose positron emission tomography/computed tomography (18F‑FDG-PET/CT). Complete lead extraction required a combined transvenous and surgical approach. Contralateral reimplantation failed due to occlusion of the right brachiocephalic vein. Therefore, a subcutaneous ICD was implanted. This case highlights the importance of an interdisciplinary approach to the treatment of cardiac implantable electronic device infection.
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Affiliation(s)
- Attila Benak
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Maria Kohari
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Besenyi
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Attila Makai
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Laszlo Saghy
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Mate Vamos
- 2nd Department of Medicine and Cardiology Center, Electrophysiology Division, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary.
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19
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Pilecky D, Fischer R, Wiesinger T, Gröbner M, Vamos M, Elsner D. Anterior wall ST-elevation myocardial infarction in biventricular paced rhythm. Herzschrittmacherther Elektrophysiol 2020; 31:228-231. [PMID: 32361770 DOI: 10.1007/s00399-020-00682-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
There is a lack of evidence on electrocardiographic criteria for ST-elevation myocardial infarction (STEMI) in patients with biventricular paced rhythm. In all previous case reports of STEMI in biventricular paced rhythm, concordant ST-elevations and/or discordant ST-elevations >5 mm were present. This report describes the case of a patient with anterior STEMI and discordant ST-elevations of less than 5 mm during biventricular stimulation with epicardial left ventricular lead and highlights the importance of comparing the electrocardiogram to previous recordings when STEMI is suspected.
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Affiliation(s)
- David Pilecky
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany.
| | - Robert Fischer
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
| | - Tanja Wiesinger
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
| | - Michael Gröbner
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
| | - Mate Vamos
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Dietmar Elsner
- Department of Internal Medicine III, Klinikum Passau, Innstraße 76, 94032, Passau, Germany
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20
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Vamos M, Calkins H, Kowey PR, Torp-Pedersen CT, Corp Dit Genti V, Wieloch M, Koren A, Hohnloser SH. Efficacy and safety of dronedarone in patients with a prior ablation for atrial fibrillation/flutter: Insights from the ATHENA study. Clin Cardiol 2019; 43:291-297. [PMID: 31872901 PMCID: PMC7068068 DOI: 10.1002/clc.23309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background The role of antiarrhythmic drugs for atrial fibrillation/atrial flutter (AF/AFL) after catheter ablation is not well established. Hypothesis We hypothesized that changing the myocardial substrate by ablation may alter the responsiveness to dronedarone. Methods We assessed the efficacy and safety of dronedarone in the treatment of paroxysmal/persistent atrial fibrillation/atrial flutter (AF/AFL) post‐ablation, based on a post hoc analysis of the ATHENA study. A total of 196 patients (dronedarone 90, placebo 106) had an ablation for AF/AFL before study entry. In these patients, the effect of treatment on the first hospitalization because of cardiovascular (CV) events/all‐cause death was assessed, as was AF/AFL recurrence in individuals with sinus rhythm at baseline. The safety of dronedarone vs placebo was also determined. Results In patients with prior ablation, dronedarone reduced the risk of AF/AFL recurrence (hazard ratio [HR]: 0.65 [95% confidence interval [CI]: 0.42, 1.00]; P < .05) as well as the median time to first AF/AFL recurrence (561 vs 180 days) compared with placebo. The HR for first CV hospitalization/all‐cause death with dronedarone vs placebo was 0.98 (95% CI: 0.62, 1.53; P = .91). Rates of treatment‐emergent adverse events were 83.1% vs 75.5% and rates of serious TEAEs were 27.0% vs 18.9% in the dronedarone and placebo groups, respectively. One death occurred with dronedarone (not treatment‐emergent) and five occurred with placebo. Conclusion In patients with prior ablation for AF/AFL, dronedarone reduced the risk of AF/AFL recurrence compared with placebo, but not the risk of first CV hospitalization/all‐cause death. Safety outcomes were consistent with those of the overall ATHENA study.
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Affiliation(s)
- Mate Vamos
- J.W. Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt, Germany.,University of Szeged, Second Department of Medicine and Cardiology Center, Szeged, Hungary
| | - Hugh Calkins
- Johns Hopkins University, Department of Medicine, Cardiology, Baltimore, Maryland
| | - Peter R Kowey
- Lankenau Heart Institute, Department of Cardiology, Wynnewood, Pennsylvania
| | | | | | - Mattias Wieloch
- Sanofi-Aventis, Paris, France.,Lund University, Department of Clinical Sciences, Malmö, Sweden
| | | | - Stefan H Hohnloser
- J.W. Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt, Germany
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Muk B, Vamos M, Bogyi P, Majoros ZS, Vagany D, Borsanyi T, Szogi E, Juhasz I, Kosa K, Dekany M, Nyeki LCS, Kiss RG, Nyolczas N. P1663The impact of highest doses of ACEi/ARB therapy on mortality of patients suffering from heart failure with reduced ejection fraction: a long-term follow-up, propensity-matched cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The angiotensin-converting enzyme inhibitors (ACEi) as cornerstone of neurohormonal drug regime reduce mortality and morbidity in heart failure with reduced ejection fraction (HFrEF) hence these drugs are recommended for every HFrEF patients without presence of contraindication or intolerance. However, there are controversial results regarding the incremental survival benefit of higher doses of these drugs used in HFrEF. In addition, achieving the highest doses (TD1) (20 mg < enalapril daily dose≤40 mg, or dose equivalent ACEi/ARB), of these drugs often accompanies side effects related to the uptitration, which may make it impossible to start other therapies proven to result in undoubtful mortality benefit (i.e. sacubitril/valsartan).
Aim
To assess the effect of TD1 of ACEi/ARB on mortality of HFrEF patients followed at a heart failure outpatient clinic (HFOC).
Methods
Data of 579 consecutive HFrEF patients, who hadn't been treated with an ACEi/ARB or were receiving ≤50% of doses equivalent with 20mg enalapril daily (TD2) at the time of initiation of care (NYHA: 3.1±0.8; LVEF: 27.5±6.6%; age: 61.1±13.0 years; male: 76.1%; ischemic: 46.8%; atrial fibrillation: 27.6%; diabetes: 34.9%; hypertension: 72.5%), followed at our HFOC was analysed. After therapy optimization (TO) ACEis/ARBs were applied in 96.5% and at least TD2 was reached in 55.9% of the total cohort, while TD1 of an ACEi/ARB was applied in 111 patients (19.2% of total cohort). BBs in 88.4%, target doses of BBs in 46.8%, MRAs in 57.0% of total cohort were used. To adjust for possible confounders, patients were matched based on the ACEi/ARB doses reached during TO applying propensity score matching (PSM) using the nearest neighbor matching (caliper: 0.2). All-cause mortality (ACM) was assessed using the Kaplan-Meier method and compared with the Cox proportional hazard model.
Results
After 7.1±4.7 years follow-up ACM of patients treated with TD1 of ACEis/ARBs was significantly lower than those treated with lower doses in the total cohort (HR=0.67; 95% CI=0.50–0.89; p=0.005). Applying multivariate Cox regression analysis the use of TD1 of an ACEi/ARB didn't remain independent predictor of survival; creatinine, NYHA f.c., age, sex, ischemic etiology were proved to be significant predictor of mortality. After PSM the survival of patients receiving TD1 of an ACEi/ARB didn't differ from those treated with lower doses (HR=0.84; 95% CI=0.61–1.14; p=0.27).
Conclusions
The current ESC guidelines recommend the use of target doses or maximal tolerated doses of ACEis or ARBs in HFrEF. In a real-world patient cohort whom all the effort was made to reach the target doses, ACM of patients treated with TD1 of an ACEi/ARB was significantly lower than those treated with lower doses, however this result wasn't independent from the patient characteristics. Beside that, after PSM the survival of patients treated with TD1 or with lower doses of an ACEi/ARB did not differ significantly.
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Affiliation(s)
- B Muk
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Vamos
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - P Bogyi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - Z S Majoros
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - D Vagany
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - T Borsanyi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - E Szogi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - I Juhasz
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - K Kosa
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Dekany
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | | | - R G Kiss
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - N Nyolczas
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
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22
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Vamos M, Calkins H, Kowey PR, Torp-Pederson CT, Corp Dit Genti V, Wieloch M, Koren A, Hohnloser SH. P1034Impact of ablation status on the efficacy and safety of dronedarone in patients with atrial fibrillation/flutter: a post-hoc analysis of the ATHENA trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite increasing use of ablation for atrial fibrillation/flutter (AF/AFL), few systematic data exist on the use of dronedarone and other antiarrhythmic drugs after ablation.
Purpose
To assess efficacy and safety of dronedarone after ablation in patients with paroxysmal/persistent AF/AFL randomized to dronedarone or placebo in the ATHENA trial (NCT00174785).
Methods
In ATHENA, 196 patients (dronedarone 90, placebo 106) had an ablation for AF/AFL prior to study entry. AF/AFL recurrence was evaluated in patients in sinus rhythm at baseline (dronedarone 63, placebo 65) by ECG during study visits or symptom recurrence.
Results
Ablated vs non-ablated patients were more likely to be male, have an implantable cardioverter defibrillator or pacemaker implanted, or be receiving an oral anticoagulant. Fewer ablated patients had an AF/AFL recurrence with dronedarone (36 [57%]) than with placebo (46 [71%]). Median time to first AF/AFL recurrence was significantly longer with dronedarone versus placebo (561 versus 180 days; hazard ratio 0.65 [95% CI 0.42–1.00], p<0.05; Fig 1). Time to first cardiovascular hospitalization or death was similar with dronedarone versus placebo (hazard ratio 0.98 [0.62–1.53]). On-treatment rates of treatment-emergent adverse events with dronedarone versus placebo were 83.1 versus 75.5%, serious treatment-emergent adverse events were 27.0 versus 18.9%, permanent drug discontinuations were 10.1 versus 15.1%, and deaths were 0 versus 1.9%.
Conclusions
Dronedarone delayed AF/AFL recurrence in patients with a prior AF/AFL ablation. Safety outcomes were consistent with the overall ATHENA trial. Adequately sized prospective studies are needed to confirm these observations. Given the sparsity of data for antiarrhythmic drugs after ablation, this retrospective analysis has merit and is useful for hypothesis generation.
Acknowledgement/Funding
Sanofi, New York, New York, Unites States of America
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Affiliation(s)
- M Vamos
- JW Goethe University, Dep. of Cardiology, Div. of Clinical Electrophysiology, Frankfurt am Main, Germany
| | - H Calkins
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - P R Kowey
- Lankenau Heart Institute, Wynnewood, Pennsylvania, United States of America
| | | | | | - M Wieloch
- Sanofi-Aventis, Paris, France; Skåne University Hospital, Malmö, Sweden
| | - A Koren
- Sanofi, New York, New York, United States of America
| | - S H Hohnloser
- JW Goethe University, Dep. of Cardiology, Div. of Clinical Electrophysiology, Frankfurt am Main, Germany
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23
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Bogyi P, Vamos M, Bari Z, Polgar B, Muk B, Nyolczas N, Kiss RG, Duray GZ. Association of Remote Monitoring With Survival in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy: Retrospective Observational Study. J Med Internet Res 2019; 21:e14142. [PMID: 31350836 PMCID: PMC6688436 DOI: 10.2196/14142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory. Objective The aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing cardiac resynchronization defibrillator therapy (CRT-D) implantation in a large-volume tertiary referral center. Methods The population of this single-center, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and conventional follow-up. Results The mean follow-up time was 28.4 (SD 18.1) months. Patients on remote monitoring were more likely to have atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and have a slightly lower functional capacity. Crude all-cause mortality of remote-monitored patients was significantly lower compared with patients followed conventionally (hazard ratio [HR] 0.368, 95% CI 0.186-0.727, P=.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR 0.361, 95% CI 0.181-0.722, P=.004). Conclusions In this single-center, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with a significantly better survival rate.
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Affiliation(s)
- Peter Bogyi
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary.,Basic and Translational Medicine, Karoly Racz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Mate Vamos
- Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Zsolt Bari
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Balazs Polgar
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Balazs Muk
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Noemi Nyolczas
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Robert Gabor Kiss
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Hungarian Defence Forces Medical Centre, Budapest, Hungary.,Basic and Translational Medicine, Karoly Racz School of PhD Studies, Semmelweis University, Budapest, Hungary
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24
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Erath JW, Benz AP, Hohnloser SH, Vamos M. Clinical outcomes after implantation of quadripolar compared to bipolar left ventricular leads in patients undergoing cardiac resynchronization therapy: a systematic review and meta-analysis. Europace 2019; 21:1543-1549. [DOI: 10.1093/europace/euz196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Some retrospective and prospective studies in heart failure patients with indication for cardiac resynchronization therapy (CRT) suggest better clinical outcomes for quadripolar (QP) left ventricular (LV) leads over bipolar (BP) leads. Although, lead failure remains an important safety concern, when using these more complex, novel electrodes. To evaluate safety and efficacy outcomes for QP vs. BP LV leads in patients receiving CRT.
Methods and results
We performed a comprehensive literature search through 2018 in PubMed, Cochrane Library, and Google Scholar databases to identify studies comparing patients with QP and BP LV CRT leads. A total of 12 studies were selected for analysis comprising 31 403 patients (QP lead: 22 429 patients; BP lead: 8974 patients). Eight studies examined the effects of CRT on survival. In these studies, use of QP electrodes was associated with significantly better survival compared to patients with BP LV leads (OR 0.61, 95% CI 0.50–0.76; P < 0.01). Clinical improval measured in New York Heart Association functional class (OR 0.59, 95% CI 0.34–1.01; P = 0.05) and hospitalization rates (OR 0.67, 95% CI 0.55–0.83; P < 0.01) were also improved in patients receiving QP leads. Lead malfunctions defined as LV lead failure resulting in lead deactivation (OR 0.57, 95% CI 0.34–0.98; P = 0.04) or LV lead dislodgement requiring LV lead replacement/repositioning (OR 0.48; 95% CI 0.31–0.75; P < 0.01) were more often encountered among patients with BP leads compared to patients with QP leads.
Conclusion
Our meta-analysis suggests distinct benefits of QP over BP electrodes in patients undergoing CRT.
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Affiliation(s)
- Julia W Erath
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, D Frankfurt, Germany
| | - Alexander P Benz
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, D Frankfurt, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, D Frankfurt, Germany
| | - Mate Vamos
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, D Frankfurt, Germany
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25
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Braun O, Vamos M, Erath JW, Hohnloser SH. How to maximize QRS narrowing. Herzschrittmacherther Elektrophysiol 2019; 30:229-232. [PMID: 30963248 DOI: 10.1007/s00399-019-0616-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) resulting in maximal QRS narrowing may be associated with improved outcomes. METHODS Various atrioventricular (AV) delay settings, including the new SyncAV™ algorithm (St. Jude Medical/Abbott, St. Paul, MN, USA), aimed at maximal QRS narrowing were tested in an 81-year old CRT recipient. RESULTS Maximal QRS narrowing from 160 to 100 ms was achieved with a manually programmed value of SyncAV™ -30 ms. At 2 months, the patient proved to be a CRT super-responder. CONCLUSION SyncAV™ algorithm is a new way for effective QRS narrowing with potentially improved outcomes.
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Affiliation(s)
- Olivia Braun
- University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Mate Vamos
- University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Julia W Erath
- University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan H Hohnloser
- Department of Cardiology, Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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26
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Vamos M, Erath JW, Benz AP, Lopes RD, Hohnloser SH. Meta-Analysis of Effects of Digoxin on Survival in Patients with Atrial Fibrillation or Heart Failure: An Update. Am J Cardiol 2019; 123:69-74. [PMID: 30539748 DOI: 10.1016/j.amjcard.2018.09.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023]
Abstract
In 2015, 3 independent meta-analyses raised concerns about digoxin therapy being associated with an increased mortality risk in patients with atrial fibrillation (AF) and with heart failure (HF). Although several other studies have been published since then fostering these safety issues, the most recent 2016 European guidelines for AF still recommend this therapy as a class I indication. We performed an updated systematic review and random-effect meta-analysis on publications up to March 2018 reporting data on digoxin associated mortality in subjects with AF or HF. Based on the adjusted survival data of all identified 37 trials comprising a total of 825,061 patients, digoxin use was associated with an increased relative risk of all-cause mortality (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05 to 1.29, p <0.01). Treatment with digoxin was associated with an increased mortality risk in the subgroup of patients with AF (n = 627,620, HR 1.23, 95% CI, 1.17 to 1.30, p <0.01), and in the subgroup of patients with HF (n = 197,441, HR 1.11, 95% CI, 1.06 to 1.16, p<0.01). A sensitivity analysis of studies reporting data on new digoxin users (n = 41,687) demonstrated an even higher risk for all-cause mortality compared with patients not receiving cardiac glycosides (HR 1.47, 95% CI, 1.15 to 1.88, p <0.01). In conclusion, this updated meta-analysis confirms that digoxin use is associated with increased mortality in patients with AF or HF.
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27
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Monsefi N, Waraich HS, Vamos M, Erath J, Sirat S, Moritz A, Hohnloser SH. Efficacy and safety of transvenous lead extraction in 108 consecutive patients: a single-centre experience. Interact Cardiovasc Thorac Surg 2018; 28:704-708. [DOI: 10.1093/icvts/ivy351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/15/2018] [Accepted: 11/25/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nadejda Monsefi
- Department of Thoracic and Cardiovascular Surgery, Heart Center Siegburg, Siegburg, Germany
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Harmeet Singh Waraich
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Mate Vamos
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Julia Erath
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Sami Sirat
- Department of Thoracic and Cardiovascular Surgery, Heart Center Siegburg, Siegburg, Germany
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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28
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Bari Z, Vamos M, Bogyi P, Reynolds D, Sheldon T, Fagan DH, Duray GZ. Physical activity detection in patients with intracardiac leadless pacemaker. J Cardiovasc Electrophysiol 2018; 29:1690-1696. [DOI: 10.1111/jce.13729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Zsolt Bari
- Department of Cardiology, Medical CentreHungarian Defence ForcesBudapest Hungary
| | - Mate Vamos
- Department of CardiologyUniversity Hospital Frankfurt, Goethe UniversityFrankfurt Germany
| | - Peter Bogyi
- Department of Cardiology, Medical CentreHungarian Defence ForcesBudapest Hungary
| | - Dwight Reynolds
- Department of MedicineCardiovascular Section, Heart Rhythm Institute, University of Oklahoma Health Sciences CenterOklahoma City Oklahoma
| | | | | | - Gabor Zoltan Duray
- Department of Cardiology, Medical CentreHungarian Defence ForcesBudapest Hungary
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29
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Vamos M, Erath JW, Benz AP, Hohnloser SH. P2777Accumulating evidence for deleterious effects of digoxin in heart failure and atrial fibrillation: an updated meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2777] [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: 11/12/2022] Open
Affiliation(s)
- M Vamos
- JW Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt am Main, Germany
| | - J W Erath
- JW Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt am Main, Germany
| | - A P Benz
- JW Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt am Main, Germany
| | - S H Hohnloser
- JW Goethe University, Department of Cardiology, Division of Clinical Electrophysiology, Frankfurt am Main, Germany
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30
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Muk B, Vamos M, Bogyi P, Szabo B, Vagany D, Majoros ZS, Szabo M, Borsanyi T, Dekany M, Duray GZ, Kiss RG, Nyolczas N. 205The impact of serum concentration guided digoxin therapy on mortality: a long-term follow-up, propensity-matched cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.205] [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: 11/14/2022] Open
Affiliation(s)
- B Muk
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Vamos
- Goethe University, Cardiology, Frankfurt am Main, Germany
| | - P Bogyi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - B Szabo
- Orebro University Hospital, Cardiology Clinic, Orebro, Sweden
| | - D Vagany
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - Z S Majoros
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Szabo
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - T Borsanyi
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - M Dekany
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - G Z Duray
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - R G Kiss
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
| | - N Nyolczas
- Medical Centre, Hungarian Defence Forces, Cardiology, Budapest, Hungary
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31
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Erath JW, Vamos M, Benz A, Bari Z, Bogyi P, Duray G, Hohnloser SH. P3214Implantation of quadripolar left-ventricular leads improves CRT response. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3214] [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: 11/12/2022] Open
Affiliation(s)
- J W Erath
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - M Vamos
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - A Benz
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - Z Bari
- Medical Centre, Hungarian Defence Forces, Cardiology/Electrophysiology, Budapest, Hungary
| | - P Bogyi
- Medical Centre, Hungarian Defence Forces, Cardiology/Electrophysiology, Budapest, Hungary
| | - G Duray
- Medical Centre, Hungarian Defence Forces, Cardiology/Electrophysiology, Budapest, Hungary
| | - S H Hohnloser
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
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32
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Erath JW, Vamos M, Benz AP, Hohnloser SH. P5737Clinical performance of quadripolar left ventricular leads compared to biventricular leads. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5737] [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)
- J W Erath
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - M Vamos
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - A P Benz
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - S H Hohnloser
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
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33
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Erath JW, Buettner S, Weiler H, Vamos M, Von Jeinsen B, Heyl S, Schalk R, Mutlak H, Zeiher AM, Fichtlscherer S, Honold J. P2733Prognostic implications of preclinical airway management with laryngeal tube (LTS-D) or endotracheal tube in out-of-hospital cardiac arrest patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2733] [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: 11/14/2022] Open
Affiliation(s)
- J W Erath
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - S Buettner
- JW Goethe University, Nephrology, Frankfurt am Main, Germany
| | - H Weiler
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - M Vamos
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - B Von Jeinsen
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Heyl
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - R Schalk
- JW Goethe University, Anaesthesiology, Frankfurt am Main, Germany
| | - H Mutlak
- JW Goethe University, Anaesthesiology, Frankfurt am Main, Germany
| | - A M Zeiher
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Fichtlscherer
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - J Honold
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
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34
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Benz A, Vamos M, Erath JW, Hohnloser SH. P1901De novo atrial fibrillation after DDD pacemaker implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1901] [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)
- A Benz
- JW Goethe University, Department of Cardiology, Division Clinical Electrophysiology, Frankfurt am Main, Germany
| | - M Vamos
- JW Goethe University, Department of Cardiology, Division Clinical Electrophysiology, Frankfurt am Main, Germany
| | - J W Erath
- JW Goethe University, Department of Cardiology, Division Clinical Electrophysiology, Frankfurt am Main, Germany
| | - S H Hohnloser
- JW Goethe University, Department of Cardiology, Division Clinical Electrophysiology, Frankfurt am Main, Germany
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35
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Benz AP, Vamos M, Erath JW, Hohnloser SH. Cephalic vs. subclavian lead implantation in cardiac implantable electronic devices: a systematic review and meta-analysis. Europace 2018; 21:121-129. [DOI: 10.1093/europace/euy165] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Alexander P Benz
- Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Mate Vamos
- Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Julia W Erath
- Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Stefan H Hohnloser
- Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
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Vamos M, Healey JS, Wang J, Connolly SJ, Mabo P, Van Erven L, Kautzner J, Glikson M, Neuzner J, O'Hara G, Vinolas X, Gadler F, Hohnloser SH. Implantable cardioverter–defibrillator therapy in hypertrophic cardiomyopathy: A SIMPLE substudy. Heart Rhythm 2018; 15:386-392. [DOI: 10.1016/j.hrthm.2017.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 11/29/2022]
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Simon A, Vamos M. Zum Beitrag „Rechtsschenkelblock, Linksschenkelblock, Schrittmacher bei akutem Koronarsyndrom – kann man das EKG hier vergessen?“. Dtsch Med Wochenschr 2017; 142:1324-1325. [DOI: 10.1055/s-0043-114836] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andras Simon
- St. Imre Lehrkrankenhaus, Kardiologie, Budapest, Ungarn
| | - Mate Vamos
- Universitätsklinikum Frankfurt, Kardiologie, Abteilung Klinische Elektrophysiologie, Frankfurt am Main
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Kosztin A, Vamos M, Aradi D, Schwertner R, Kovacs A, Nagy K, Zima E, Geller L, Duray G, Kutyifa V, Merkely B. P5475De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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39
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Benz A, Vamos M, Erath J, Hohnloser S. P1668Cephalic versus subclavian lead implantation in cardiac implantable electronic devices: a systematic review and comprehensive meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Vamos M, Nyolczas N, Bari Z, Bogyi P, Muk B, Szabo B, Ancsin B, Kiss RG, Duray GZ. Refined heart failure detection algorithm for improved clinical reliability of OptiVol alerts in CRT-D recipients. Cardiol J 2017; 25:236-244. [PMID: 28653309 DOI: 10.5603/cj.a2017.0077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/04/2017] [Revised: 05/05/2017] [Accepted: 05/28/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The reliability of intrathoracic impedance monitoring for prediction of heart failure (HF) by implantable cardiac devices is controversial. Despite using additional device-based parameters described in the PARTNERS HF study, such as new onset of arrhythmias, abnormal autonomics, low biventricular pacing rate or patient activity level, the predictive power of device diagnostic algorithm is still in doubt. The objective of this study was to compare the device diagnostic algorithm described in the PARTNERS HF study to a newly developed algorithm applying refined diagnostic criteria. METHODS Fourty two patients were prospectively enrolled who had been implanted with an intrathoracic impedance and remote monitoring capable implantable cardiac defibrillator with a cardiac resychroniza-tion therapy (CRT-D) device in this observational study. If a remote OptiVolTM alert occurred, patients were checked for presence of HF symptoms. A new algorithm was derived from the original PARTNERS HF criteria, considering more sensitive cut-offs and changes of patterns of the device-based parameters. RESULTS During an average follow-up of 38 months, 722 remote transmissions were received. From the total of 128 transmissions with OptiVol alerts, 32 (25%) corresponded to true HF events. Upon multivariate discriminant analysis, low patient activity, high nocturnal heart rate, and low CRT pacing (< 90%) proved to be independent predictors of true HF events (all p < 0.01). Incorporating these three refined criteria in a new algorithm, the diagnostic yield of OptiVol was improved by increasing specific-ity from 37.5% to 86.5%, positive predictive value from 34.1% to 69.8% and area under the curve from 0.787 to 0.922 (p < 0.01), without a relevant loss in sensitivity (96.9% vs. 93.8%). CONCLUSIONS A refined device diagnostic algorithm based on the parameters of low activity level, high nocturnal heart rate, and suboptimal biventricular pacing might improve the clinical reliability of OptiVol alerts.
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Affiliation(s)
- Mate Vamos
- University Hospital Frankfurt - Goethe University.
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Vamos M, Bogyi P, Duray GZ, Nyolczas N, Hohnloser SH. Ventricular rate stabilization for treatment of recurrent VT. Herzschrittmacherther Elektrophysiol 2017; 28:239-242. [PMID: 28567490 DOI: 10.1007/s00399-017-0513-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 10/19/2022]
Abstract
A patient with ischaemic cardiomyopathy received a secondary prevention VVI implantable cardioverter-defibrillator (ICD) after an episode of sustained ventricular tachycardia (VT). Because of recurrent VTs transmitted via CareLink, medical therapy was optimized and VT ablation was performed. Subsequently, a fast VT with a typical short-long-short initiation developed. In addition, there was an increasing need for ventricular pacing due to sinus bradycardia. This new type of VT could be successfully dealt with by upgrading to DDD ICD and activating the Ventricular Rate Stabilization algorithm.
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Affiliation(s)
- Mate Vamos
- Department of Cardiology, University Hospital Frankfurt - Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Peter Bogyi
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Gabor Z Duray
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Noemi Nyolczas
- Department of Cardiology, Medical Centre - Hungarian Defence Forces, Budapest, Hungary
| | - Stefan H Hohnloser
- Department of Cardiology, University Hospital Frankfurt - Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Kosztin A, Vamos M, Aradi D, Schweltner W, Bojtar ZS, Kovacs A, Geller L, Zima E, Kutyifa V, Merkely B. P264De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis. Europace 2017. [DOI: 10.1093/ehjci/eux171.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bari Z, Vamos M, Bogyi P, Jaszko M, Duray G. P438Safety and efficacy of the Micra Transcatheter Pacemaker in different right ventricular positions. Europace 2017. [DOI: 10.1093/ehjci/eux141.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hohnloser SH, Vamos M. Not All Types of Atrial Fibrillation Carry the Same Stroke Risk, but Most Benefit From Oral Anticoagulation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004847. [DOI: 10.1161/circep.116.004847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Affiliation(s)
- Stefan H. Hohnloser
- From the Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany
| | - Mate Vamos
- From the Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany
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Erath JW, Sirat AS, Vamos M, Hohnloser SH. Epicardial CRT-P- and S-ICD Implantation in a Young Patient with Persistent Left Superior Vena Cava. Herzschrittmacherther Elektrophysiol 2016; 27:396-398. [PMID: 27645220 DOI: 10.1007/s00399-016-0451-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
Persistent left superior vena cava is known to be a challenging anatomic abnormality for transvenous cardiac device implantation. In the a case of a young man presenting with dilative cardiomyopathy with severely impaired left ventricular ejection fraction (LVEF) and second-degree atrioventricular block (AV block), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) implantation was indicated. A transvenous approach was attempted, but placement of the right ventricular lead was not successful due to anatomic abnormalities. Therefore, epicardial CRT leads were implanted via a left mini-thoracotomy. For primary prevention of sudden death, the patient was also fitted with an additional subcutaneous implantable cardioverter defibrillator (S-ICD). Any cross-talk between the devices was ruled out both intraoperatively and by ergometry prior to discharge. The combination of epicardial CRT-P with S‑ICD implantation might be a safe and effective alternative in patients with cardiac anatomic abnormalities.
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Affiliation(s)
- Julia W Erath
- Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Abdul Sami Sirat
- Dep. of Cardio-Thoracic Surgery, Helios Klinikum Siegburg, Siegburg, Germany
| | - Mate Vamos
- Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Stefan H Hohnloser
- Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Erath JW, Vamos M, Sirat AS, Hohnloser SH. The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients. Clin Res Cardiol 2016; 106:300-306. [PMID: 27888304 DOI: 10.1007/s00392-016-1054-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/17/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The wearable cardioverter-defibrillator (WCD) is used for temporary protection of patients deemed to be at high risk for sudden death (SCD) not yet meeting indications for the implantable defibrillator (ICD). OBJECTIVES To evaluate the efficacy, safety, and compliance of/to WCD use and subsequent medium-term outcome of patients in a single-center observational study. METHODS A total of 102 consecutive patients were fitted with the WCD from 2012 to 2015 and followed for a mean of 11 months (±8 months). RESULTS The most common clinical indication for WCD-prescription (63%) was a new diagnosis of severely impaired LV function (LVEF ≤35%). The median wear time of the WCD was 54 days with a daily use of 23 h. Appropriate WCD therapy occurred in four patients (seven shocks for VF, one shock for VT). An ICD was finally implanted in 56 patients (55%). Improvement in LV function was the most common reason not to implant an ICD (HR 0.37; 95% CI 0.19-0.73; p = 0.004). Two patients had inappropriate shocks from their WCD due to atrial fibrillation/flutter. Five patients fitted with an ICD after the end of WCD therapy suffered VT/VF episodes. After wearing the WCD, six patients died (five ICD recipients and one non-ICD recipient). CONCLUSION WCD therapy was well accepted by patients and provided temporary protection against ventricular tachyarrhythmias in patients at risk for SCD. The WCD may help to avoid unnecessary ICD implantations in a significant proportion of patients.
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Affiliation(s)
- Julia W Erath
- Goethe University Hospital, Frankfurt, Hessen, Germany.
| | - Mate Vamos
- Goethe University Hospital, Frankfurt, Hessen, Germany
| | - Abdul Sami Sirat
- Goethe University Hospital, Frankfurt, Hessen, Germany
- Helios Klinikum Siegburg, Siegburg, Germany
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Vamos M, Hohnloser SH. Amiodarone and dronedarone: An update. Trends Cardiovasc Med 2016; 26:597-602. [DOI: 10.1016/j.tcm.2016.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/14/2016] [Accepted: 03/31/2016] [Indexed: 10/22/2022]
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Vamos M, Honold J, Duray GZ, Hohnloser SH. MICRA Leadless Pacemaker on Autopsy. JACC Clin Electrophysiol 2016; 2:636-637. [DOI: 10.1016/j.jacep.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
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Erath JW, Vamos M, Hohnloser SH. Effects of digitalis on mortality in a large cohort of implantable cardioverter defibrillator recipients: results of a long-term follow-up study in 1020 patients. Eur Heart J Cardiovasc Pharmacother 2016; 2:168-74. [DOI: 10.1093/ehjcvp/pvw008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/30/2016] [Indexed: 11/14/2022]
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Bushoven P, Linzbach S, Vamos M, Hohnloser SH. Optimal Anticoagulation Strategy for Cardioversion in Atrial Fibrillation. Arrhythm Electrophysiol Rev 2016; 4:44-6. [PMID: 26835099 DOI: 10.15420/aer.2015.4.1.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/08/2014] [Accepted: 01/19/2015] [Indexed: 11/04/2022] Open
Abstract
For many patients with symptomatic atrial fibrillation, cardioversion is performed to restore sinus rhythm and relieve symptoms. Cardioversion carries a distinct risk for thromboembolism which has been described to be in the order of magnitude of 1 to 3 %. For almost five decades, vitamin K antagonist therapy has been the mainstay of therapy to prevent thromboembolism around the time of cardioversion although not a single prospective trial has formally established its efficacy and safety. Currently, three new direct oral anticoagulants are approved for stroke prevention in patients with non-valvular atrial fibrillation. For all three, there are data regarding its usefulness during the time of electrical or pharmacological cardioversion. Due to the ease of handling, their efficacy regarding stroke prevention, and their safety with respect to bleeding complications, the new direct oral anticoagulants are endorsed as the preferred therapy over vitamin K antagonists for stroke prevention in non-valvular atrial fibrillation including the clinical setting of elective cardioversion.
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Affiliation(s)
- Philipp Bushoven
- Department of Cardiology, Division of Clinical Electrophysiology, JW Goethe University, Frankfurt, Germany
| | - Sven Linzbach
- Department of Cardiology, Division of Clinical Electrophysiology, JW Goethe University, Frankfurt, Germany
| | - Mate Vamos
- Department of Cardiology, Division of Clinical Electrophysiology, JW Goethe University, Frankfurt, Germany
| | - Stefan H Hohnloser
- Department of Cardiology, Division of Clinical Electrophysiology, JW Goethe University, Frankfurt, Germany
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