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Marion W, Schanz JD, Patel S, Co ML, Pavri BB. Single operator experience, learning curve, outcomes, and insights gained with conduction system pacing. Pacing Clin Electrophysiol 2024; 47:211-221. [PMID: 38265169 DOI: 10.1111/pace.14926] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Conduction system pacing (CSP) is increasingly utilized to prevent and correct dyssynchrony. Barriers to CSP adoption include limited training, methodologic variability, laboratory slot allocation, and few data on learning curves. We report learning curves/clinical outcomes from a single experienced electrophysiologist who was new to CSP, and share gained insights. METHODS Retrospective analysis of all patients who underwent attempted CSP implantation (2016-2023). Patient characteristics, ECGs, echocardiograms, fluoroscopy/procedure times, lead data were recorded at implant and follow-up. RESULTS CSP leads were implanted successfully in 167/191(87.4%) patients with a follow-up of 278 ± 378 days. His-bundle pacing (HBP = 59) and left-bundle-area pacing (LBAP = 108) had similar procedure/fluoroscopy times, QRS duration decreases, and ejection fraction improvements (all p > NS). Eight HBP lead revisions were required for high capture thresholds LBAP demonstrated lower pacing thresholds, higher lead impedances, and greater R-wave amplitudes at implant and follow-up. After 25 HBP cases, implant pacing thresholds, fluoroscopy, procedural times did not decrease. After 25 LBAP cases, there were significant decreases in all these parameters (p < 0.05). A separate analysis in LBAP patients with recorded Purkinje signals showed no differences in paced ECG characteristics between patients with pre- QRS Purkinje signals versus patients with Purkinje signals post-QRS onset. CONCLUSIONS Experienced implanters who are new to CSP can achieve steady-state procedural/fluoroscopy times after a learning curve of 25 implants. LBAP showed lower capture thresholds and higher success rates. Adequate depth of lead deployment (as determined by published parameters) does not require Purkinje potential to be pre-QRS. Operators new to CSP.can forego HBP and directly implement LBAP.
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Affiliation(s)
- William Marion
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Sonali Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Lawrenz Co
- Division of Cardiology, Section of Cardiac Electrophysiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Behzad B Pavri
- Division of Cardiology, Section of Cardiac Electrophysiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Rivera FB, Cha SW, Aparece JP, Gonzales JST, Salva WFC, Bantayan NRB, Carado GP, Sharma V, Al-Abcha A, Co ML, Collado FMS, Volgman AS. Sex differences in permanent pacemaker implantation after transcatheter aortic valve replacement: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:631-641. [PMID: 37608465 DOI: 10.1080/14779072.2023.2250719] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND There is limited evidence on the effect of sex on permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). The primary objective of this meta-analysis was to determine the role of sex among patients requiring PPMI post-TAVR. METHODS A literature search was conducted using the SCOPUS, MEDLINE, and CINAHL databases for studies published until October 2022. Eligible studies included published randomized controlled trials (RCTs) and Observational Cohort Studies (OCS) articles that reported PPMI as an outcome of pacemaker status following TAVR. This study was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Publication bias was estimated using a Funnel plot and Egger's test. Data were pooled using a random-effects model. The primary endpoint was the sex difference in PPMI after TAVR, with odds ratios and 95% confidence intervals (CIs) extracted. RESULTS Data was obtained from 63 studies, and a total of 79,655 patients were included. The cumulative PPMI rate was 15.5% (95% CI, 13.6%-17.7%). The pooled analysis revealed that while there were more females than males undergoing TAVR (51.6%, 95% CI 50.4%-52.8%), males have a 14.5% higher risk for post-TAVR PPMI than females (OR 1.145, 95% CI 1.047-1.253, P < 0.01). CONCLUSIONS Males are more likely to experience PPMI after TAVR than females. Further research needs to be done to better explain these observed differences in outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Vikram Sharma
- Department of Cardiology, University of Iowa Hospitals and Clinics, Lowa City, IA, USA
| | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael Lawrenz Co
- Section of Clinical Cardiac Electrophysiology, Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
PURPOSE OF THE REVIEW Dyssynchrony occurs when portions of the cardiac chambers contract in an uncoordinated fashion. Ventricular dyssynchrony primarily impacts the left ventricle and may result in heart failure. This entity is recognized as a major contributor to the development and progression of heart failure. A hallmark of dyssynchronous heart failure (HFd) is left ventricular recovery after dyssynchrony is corrected. This review discusses the current understanding of pathophysiology of HFd and provides clinical examples and current techniques for treatment. RECENT FINDINGS Data show that HFd responds poorly to medical therapy. Cardiac resynchronization therapy (CRT) in the form of conventional biventricular pacing (BVP) is of proven benefit in HFd, but is limited by a significant non-responder rate. Recently, conduction system pacing (His bundle or left bundle branch area pacing) has also shown promise in correcting HFd. HFd should be recognized as a distinct etiology of heart failure; HFd responds best to CRT.
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Affiliation(s)
- Sean J Dikdan
- Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | | | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
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Ali S, Saadat V, Co ML, Contractor T, Mandapati R, Parwani P. Permanent left atrial thrombi after multiple atrial fibrillation ablations: Acquired Virchow’s triad? HeartRhythm Case Rep 2022; 8:715-718. [PMCID: PMC9596357 DOI: 10.1016/j.hrcr.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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Co ML, Smith J, Mandapati R, Ali S, Cooper KM, Contractor T. B-PO01-107 “CATCH AND SNARE” TECHNIQUE FOR RETRIEVAL OF A HYPERMOBILE DETACHED LEADLESS PACEMAKER. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.251] [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: 10/20/2022]
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Contractor T, Co ML, Cooper J. Is there a way to confirm true septal placement of leadless pacemakers? Proposal of the "RAO space" sign. Pacing Clin Electrophysiol 2020; 44:176-177. [PMID: 33283903 DOI: 10.1111/pace.14138] [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] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Joshua Cooper
- Temple University Health System, Philadelphia, Pennsylvania, USA
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Contractor T, Co ML, Cooper JM, Mandapati R, Abudayyeh I. Management of inadvertent lead placement in the left ventricle via a patent foramen ovale: A multidisciplinary approach. HeartRhythm Case Rep 2020; 6:89-93. [PMID: 32099797 PMCID: PMC7026559 DOI: 10.1016/j.hrcr.2019.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Michael Lawrenz Co
- Loma Linda University Medical Center, Loma Linda, California
- Address reprint requests and correspondence: Dr Michael Lawrenz Co, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354.
| | | | - Ravi Mandapati
- Loma Linda University Medical Center, Loma Linda, California
| | - Islam Abudayyeh
- Loma Linda University Medical Center, Loma Linda, California
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Agdamag AC, Gevorgyan O, Lawrenz Co M, Hassan S. Multiple cutaneous and mucosal lesions in a patient with cocaine-levamisole-induced vasculopathy syndrome. Proc AMIA Symp 2019; 32:93-95. [PMID: 30956595 DOI: 10.1080/08998280.2018.1503478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/22/2018] [Revised: 07/14/2018] [Accepted: 07/19/2018] [Indexed: 10/27/2022] Open
Abstract
Levamisole is an adulterant found in nearly 70% of cocaine in the United States. The concomitant use of levamisole and cocaine leads to a distinct clinical syndrome that typically manifests as agranulocytosis, leukocytoclastic vasculitis, and elevated antineutrophil cytoplasmic antibody (ANCA) levels. Systemic involvement has also been rarely reported with this syndrome. This is a case of a 51-year-old woman with chronic cocaine use who initially presented with multiple cutaneous ulcerations and was later found to have pulmonary and renal involvement. Infectious workup was unrevealing and autoimmune workup revealed highly elevated levels of perinuclear ANCA. Due to continuous cocaine use despite counseling, the patient was readmitted with worsening pulmonary and renal manifestations requiring initiation of immunosuppressive therapy.
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Affiliation(s)
| | - Ofelya Gevorgyan
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical CenterChicagoIllinois
| | - Michael Lawrenz Co
- Department of Internal Medicine, Rush University Medical CenterChicagoIllinois
| | - Sobia Hassan
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical CenterChicagoIllinois
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Co ML, Ji Y, Bato M, Lo R. GASTROPARESIS: A RARE BUT REVERSIBLE COMPLICATION OF ATRIAL FIBRILLATION ABLATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32933-x] [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: 11/25/2022]
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Co ML, Patel H, Bai C. TRANSCATHETER THERAPIES FOR REFRACTORY SYMPTOMATIC SEVERE TRICUSPID RERGURGITATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32867-5] [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: 10/17/2022]
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Agdamag ACC, Co ML, Co MZ, Hertl M, Mohamedali B. Hyperdynamic Left Ventricular Ejection Fraction is Associated with Increased Mortality after Kidney Transplantation. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.370] [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: 11/26/2022]
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Affiliation(s)
- Michael Lawrenz Co
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Marcus Juan Esteban
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Co ML, Patel H, Okwuosa T. FIBROSING MEDIASTINITIS-RELATED PULMONARY ARTERY AND VEIN STENOSIS LIMITING CHEMOTHERAPY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35559-6] [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: 11/25/2022]
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Co ML, Okwuosa T, Das A. PSEUDO-WELLEN'S SYNDROME AFTER MARIJUANA USE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31167-6] [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: 10/22/2022]
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