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Schnur A, Rav Acha M, Loutati R, Perel N, Taha L, Zacks N, Maller T, Karmi M, Bayya F, Levi N, Sabouret P, Fink N, Marmor D, Shuvy M, Glikson M, Asher E. Incidence of Ventricular Fibrillation and Sustained Ventricular Tachycardia Complicating Non-ST Segment Elevation Myocardial Infarction. J Clin Med 2024; 13:2286. [PMID: 38673559 PMCID: PMC11050986 DOI: 10.3390/jcm13082286] [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: 03/04/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Primary ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) are potentially lethal complications in patients suffering from acute myocardial infarction (MI). In contrast with the profound data regarding the incidence and prognostic value of ventricular arrhythmias in ST elevation myocardial infarction (STEMI) patients, data regarding contemporary non-ST elevation myocardial infarction (NSTEMI) patients with ventricular arrhythmias is scarce. The aim of the current study was to investigate the incidence of VF/VT complicating NSTEMI among patients admitted to an intensive coronary care unit (ICCU). Methods: Prospective, single-center study of patients diagnosed with NSTEMI admitted to ICCU between June 2019 and December 2022. Data including demographics, presenting symptoms, comorbid conditions, and physical examination, as well as laboratory and imaging data, were analyzed. Patients were continuously monitored for arrhythmias during their admission. The study endpoint was the development of VF/sustained VT during admission. Results: A total of 732 patients were admitted to ICCU with a diagnosis of NSTEMI. Of them, six (0.8%) patients developed VF/VT during their admission. Nevertheless, three were excluded after they were misdiagnosed with NSTEMI instead of posterior ST elevation myocardial infarction (STEMI). Hence, only three (0.4%) NSTEMI patients had VF/VT during admission. None of the patients died during 1-year follow-up. Conclusions: VF/VT in NSTEMI patients treated according to contemporary guidelines including early invasive strategy is rare, suggesting these patients may not need routine monitoring and ICCU setup.
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Affiliation(s)
- Asher Schnur
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Moshe Rav Acha
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Ranel Loutati
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Nimrod Perel
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Louay Taha
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Netanel Zacks
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Tomer Maller
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Mohammad Karmi
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Feras Bayya
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Nir Levi
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Pierre Sabouret
- ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75005 Paris, France;
- Department of Cardiology, National College of French Cardiologists, 13 Rue Niepce, 75014 Paris, France
| | - Noam Fink
- Assuta Medical Centers, Tel Aviv 6329302, Israel;
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - David Marmor
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Mony Shuvy
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Michael Glikson
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Elad Asher
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
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Dadon Z, Rav Acha M, Orlev A, Carasso S, Glikson M, Gottlieb S, Alpert EA. Artificial Intelligence-Based Left Ventricular Ejection Fraction by Medical Students for Mortality and Readmission Prediction. Diagnostics (Basel) 2024; 14:767. [PMID: 38611680 PMCID: PMC11011323 DOI: 10.3390/diagnostics14070767] [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: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making. AIM To assess the association of reduced (<50%) left-ventricular ejection fraction (LVEF) based on prospective point-of-care ultrasound operated by medical students using an artificial intelligence (AI) tool and 1-year primary composite outcome, including mortality and readmission for cardiovascular-related causes. METHODS Eight trained medical students used a hand-held ultrasound device (HUD) equipped with an AI-based tool for automatic evaluation of the LVEF of non-selected patients hospitalized in a cardiology department from March 2019 through March 2020. RESULTS The study included 82 patients (72 males aged 58.5 ± 16.8 years), of whom 34 (41.5%) were diagnosed with AI-based reduced LVEF. The rates of the composite outcome were higher among patients with reduced systolic function compared to those with preserved LVEF (41.2% vs. 16.7%, p = 0.014). Adjusting for pertinent variables, reduced LVEF independently predicted the composite outcome (HR 2.717, 95% CI 1.083-6.817, p = 0.033). As compared to those with LVEF ≥ 50%, patients with reduced LVEF had a longer length of stay and higher rates of the secondary composite outcome, including in-hospital death, advanced ventilatory support, shock, and acute decompensated heart failure. CONCLUSION AI-based assessment of reduced systolic function in the hands of medical students, independently predicted 1-year mortality and cardiovascular-related readmission and was associated with unfavorable in-hospital outcomes. AI utilization by novice users may be an important tool for risk stratification for hospitalized patients.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Hadassah Medical Center—Ein Kerem, Jerusalem 9112001, Israel
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Perel N, Tovia-Brodie O, Schnur A, Acha MR, Levi N, Cohen Y, Dvir D, Glikson M, Michowitz Y. Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance. Europace 2023; 26:euae011. [PMID: 38225168 PMCID: PMC10808043 DOI: 10.1093/europace/euae011] [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: 09/21/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
AIMS Conduction abnormalities post-transcatheter aortic valve implantation (TAVI) are common. Post-TAVI PR prolongation was mainly studied as an adjunct to new-onset bundle branch block. The net effect of isolated PR prolongation (IPRP) without post-TAVI QRS changes is not well known. The aim of this study was to define the incidence and clinical significance of post-TAVI IPRP. METHODS AND RESULTS A total of 1108 consecutive TAVI patients were reviewed. Patients with IPRP were compared with patients without post-TAVI electrocardiogram (ECG) changes. Clinical outcomes included permanent pacemaker implantation (PPI) and overall mortality. A total of 146 patients with IPRP were compared with 290 patients without post-TAVI ECG changes. At 1 year follow-up, 4 (2.7%) and 7 (2.4%) patients underwent PPI (P = 0.838) and 10 (6.8%) and 25 (8.6%) died (P = 0.521), from the study and control groups, respectively. No patient with IPRP and narrow QRS underwent PPI during 1 year post-TAVI, and all death events were non-cardiac except one unknown cause. Permanent pacemaker implantation rates among patients with IPRP and wide QRS were higher (n = 4, 12.1%), compared with patients with wide QRS without post-TAVI ECG change (n = 3, 4%) however not reaching statistical significance (P = 0.126). Multivariate Cox proportional hazards model demonstrated that in patients with narrow QRS, neither PR prolongation nor baseline or maximal PR intervals was associated with the combined endpoint of PPI and mortality. However, in patients with wide QRS, baseline PR intervals and QRS width, but not PR prolongation were associated with the combined outcome. CONCLUSION Post-TAVI IPRP in patients with narrow QRS is not associated with adverse outcome. This finding may translate clinically into a more permissive approach to these patients.
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Affiliation(s)
- Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Asher Schnur
- Department of Internal Medicine C, Shaare Zedek Medical Center,12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yogev Cohen
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Danny Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Rav Acha M, Tovia-Brodie O, Michowitz Y, Bayya F, Shaheen FF, Abuhatzera S, Medina A, Glikson M, Wolak A. Cryoballoon-Induced Circumferential Pulmonary Vein Fibrosis, Assessed by Late Gadolinium-Enhancement Cardiac Magnetic Resonance Imaging, and Its Correlation with Clinical Atrial Fibrillation Recurrence. J Clin Med 2023; 12:jcm12062442. [PMID: 36983442 PMCID: PMC10056270 DOI: 10.3390/jcm12062442] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Prior studies evaluating post-atrial fibrillation (AF) ablation pulmonary vein (PV) ostial gaps via magnetic resonance imaging (MRI) have shown circumferential PV fibrosis in a minority of patients, and their correlation with AF recurrence was weak. These studies were mostly based on radio-frequency AF ablations. AIM We aimed to assess cryoballoon ablation-induced PV fibrosis via MRI and its correlation with AF recurrence. METHODS AND RESULTS This was a prospective study of consecutive patients with symptomatic AF who underwent pre- and post-ablation MRI to assess baseline and ablation-induced fibrosis, respectively. Post-ablation PV gaps were assessed by new semi-quantitative visual analysis assisted by computerized ADAS analysis. AF recurrence monitored via multiple ECGs and event monitoring at 6 and 12 months post ablation. Nineteen patients with 80 PVs were included, age 56 ± 11, with paroxysmal and persistent AF in 17/19 and 2/19 patients, respectively. Baseline MRI showed minimal LA fibrosis. All patients underwent successful cryoballoon PV electrical isolation. Post-ablation MRI revealed circumferential PV fibrosis among 63/80 (78.8%) PVs and partial fibrosis with major gaps among 17/80 (21.2%) PVs. AF recurred within one year in 5/9 (55.5%) patients with partial PV fibrosis, while no AF recurred among the 10 patients in whom all PVs had circumferential fibrosis (p < 0.01). Similarly, there were significantly more PVs without circumferential fibrosis (due to major gaps) among patients with AF recurrence as compared with patients without AF recurrence (42.9% vs. 13.5%; p < 0.01). CONCLUSION Cryoballoon AF ablation results in circumferential PV fibrosis in the majority of PVs, as assessed by a new clinically relevant MRI-LGE analysis. Significant correlation was found between major PV gaps on post-ablation MRI and AF recurrence, suggesting that MRI might have the ability to predict AF recurrence.
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Affiliation(s)
- Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Feras Bayya
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Fauzi F Shaheen
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Shalom Abuhatzera
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Aharon Medina
- Shamir Medical Center, Cardiology Department, Be'er-Yaakov 7033001, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 900050, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Hospital, Jerusalem 9112102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
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Rav Acha M, Glikson M. Type 2 diabetes mellitus association with atrioventricular block. Eur Heart J 2023; 44:762-764. [PMID: 36617274 DOI: 10.1093/eurheartj/ehac755] [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: 01/09/2023] Open
Affiliation(s)
- Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Hans Beyth St, POB 3235, 91031 Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Hans Beyth St, POB 3235, 91031 Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Milman A, Nof E, Rav Acha M, Beinart R, Kutyifa V, Merkely B, Regev E, Biffi M, Cha YM, Ovdat T, Klempfner R, Glikson M. Outcome and safety of intraoperative defibrillation testing during device replacement: the Simpler trial. Europace 2023; 25:956-960. [PMID: 36636968 PMCID: PMC10062357 DOI: 10.1093/europace/euac282] [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: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Intraoperative defibrillation testing (DT) during implant or replacement of implantable cardioverter-defibrillators (ICDs) has been a matter of debate for many years. This debate was put to rest by the Simple and Nordic ICD trials, and the practice of testing during new implantations has essentially been almost abandoned. Old registries demonstrated an increased incidence of significant findings in DT during replacements. The aim of the present study was to evaluate frequency of significant findings and safety of DT in subjects undergoing device replacement. METHODS AND RESULTS A prospective observational multi-centre study included consecutive patients undergoing ICD generator replacement. The primary outcome was a failure to terminate induced ventricular fibrillation (VF) with a single shock 10 J below the maximal capacity of the device. Secondary outcomes included complications of DT. Patients were followed-up at 1- and 6-months post-procedure. A total of 92 patients were eligible, and consented to the study, of which 84 underwent DT during battery replacement. The median age was 68 years and 79.8% were males. Induction of VF was successful in 84 patients as was a successful conversion on the first attempt in all. There were no procedure-related complications. During follow up one patient had two appropriate ICD shock events. In four patients, ICD programming was changed. None suffered inappropriate shock. There was no evidence of lead malfunction. Two deaths occurred, none of which was related to arrhythmia. CONCLUSION The present study found DT was not associated with complications in patients undergoing ICD generator replacement but produced no clinically important information.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, PO Box 3235, Jerusalem 9103102, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Valentina Kutyifa
- University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, Box 653 Rochester, NY 14642, USA
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Határőr street 18, Budapest, Hungary
| | - Ehud Regev
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Mauro Biffi
- Institute of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy
| | - Yong-Mei Cha
- Mayo Clinic, 200 First St. SW Rochester, Minnesota 55905, USA
| | - Tal Ovdat
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel
| | - Robert Klempfner
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, PO Box 3235, Jerusalem 9103102, Israel
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Perel N, Tovia-Brodie O, Rav Acha M, Accinelli S, Levy EE, Glikson M, Michowitz Y. Lack of magnet use during chest compressions leads to multiple inappropriate shocks by a subcutaneous implantable cardioverter-defibrillator. HeartRhythm Case Rep 2022; 8:815-819. [PMID: 36620368 PMCID: PMC9811013 DOI: 10.1016/j.hrcr.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | | | | | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel,Address reprint requests and correspondence: Dr Yoav Michowitz, Department of Cardiology, Shaare Zedek Hospital, 12 Shmuel Beit St, Jerusalem 9103102, Israel.
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8
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Tovia-Brodie O, Rav Acha M, Belhassen B, Gasperetti A, Schiavone M, Forleo GB, Guevara-Valdivia ME, Ruiz DV, Lellouche N, Hamon D, Castagno D, Bellettini M, De Ferrari GM, Laredo M, Carvès JB, Ignatiuk B, Pasquetto G, De Filippo P, Malanchini G, Pavri BB, Raphael C, Rivetti L, Mantovan R, Chinitz J, Harding M, Boriani G, Casali E, Wan EY, Biviano A, Macias C, Havranek S, Lazzerini PE, Canu AM, Zardini M, Conte G, Cano Ó, Casella M, Rudic B, Omelchenko A, Mathuria N, Upadhyay GA, Danon A, Schwartz AL, Maury P, Nakahara S, Goldenberg G, Schaerli N, Bereza S, Auricchio A, Glikson M, Michowitz Y. Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey. Heart Rhythm 2022; 19:206-216. [PMID: 34710561 PMCID: PMC8547796 DOI: 10.1016/j.hrthm.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) implantation rates as well as the clinical and procedural characteristics and outcomes in patients with known active coronavirus disease 2019 (COVID-19) are unknown. OBJECTIVE The purpose of this study was to gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an international survey. METHODS Fifty-three centers from 13 countries across 4 continents provided information on 166 patients with known active COVID-19 who underwent a CIED procedure. RESULTS The CIED procedure rate in 133,655 hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000 patients (P <.001). Most devices were implanted due to high-degree/complete atrioventricular block (112 [67.5%]) or sick sinus syndrome (31 [18.7%]). Of the 166 patients in the study survey, the 30-day complication rate was 13.9% and the 180-day mortality rate was 9.6%. One patient had a fatal outcome as a direct result of the procedure. Differences in patient and procedural characteristics and outcomes were found between Europe and North America. An older population (76.6 vs 66 years; P <.001) with a nonsignificant higher complication rate (16.5% vs 7.7%; P = .2) was observed in Europe vs North America, whereas higher rates of critically ill patients (33.3% vs 3.3%; P <.001) and mortality (26.9% vs 5%; P = .002) were observed in North America vs Europe. CONCLUSION CIED procedure rates during known active COVID-19 disease varied greatly, from 0 to 16.2 per 1000 hospitalized COVID-19 patients worldwide. Patients with active COVID-19 infection who underwent CIED implantation had high complication and mortality rates. Operators should take these risks into consideration before proceeding with CIED implantation in active COVID-19 patients.
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Affiliation(s)
- Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Jerusalem, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alessio Gasperetti
- Cardiology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | | | - Milton E Guevara-Valdivia
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza IMSS, CDMX, Mexico City, México
| | - David Valdeolivar Ruiz
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza IMSS, CDMX, Mexico City, México
| | - Nicolas Lellouche
- Henri Mondor University Hospital Cardiology Unit Creteil, Paris, France
| | - David Hamon
- Henri Mondor University Hospital Cardiology Unit Creteil, Paris, France
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Matteo Bellettini
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Mikael Laredo
- AP. HP-Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Baptiste Carvès
- AP. HP-Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Barbara Ignatiuk
- Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", Monselice, Italy
| | | | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo (BG), Italy
| | - Giovanni Malanchini
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo (BG), Italy
| | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Craig Raphael
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Luigi Rivetti
- Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano (TV), Italy
| | - Roberto Mantovan
- Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano (TV), Italy
| | - Jason Chinitz
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, New York
| | - Melissa Harding
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, New York
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Carlos Macias
- UCLA Cardiac Arrhythmia Center, Los Angeles, California
| | - Stepan Havranek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio M Canu
- Azienda Ospedaliero-Universitaria Pisana, Cardiothoracic and Vascular Department, Cardiovascular Unit II, Pisa, Italy
| | - Marco Zardini
- Division of Cardiology, University Hospital "Ospedale Maggiore", Parma, Italy
| | - Giulio Conte
- Electrophysiology Unit, Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Óscar Cano
- Arrhythmia Section, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Michela Casella
- Clinic of Cardiology and Arrhythmology, University Hospital "Ospedali Riuniti", Department of Clinical, Special and Dental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Boris Rudic
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Germany, and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | | | - Nilesh Mathuria
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Cardiology Associates, Houston, Texas
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Division of Cardiology, Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Asaf Danon
- Electrophysiology Unit, Cardiology Department, Carmel Medical Center, Haifa, Israel
| | - Arie Lorin Schwartz
- Cardiology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Gustavo Goldenberg
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicolas Schaerli
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sergiy Bereza
- Cardiology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Angelo Auricchio
- Electrophysiology Unit, Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
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9
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Rav Acha M, Taha L, Turyan A, Farkash R, Bayya F, Karmi M, Steinmetz Y, Shaheen FF, Perel N, Hamayel K, Levi N, Karameh H, Tvito A, Glikson M, Asher E. D-Dimer as a Prognostic Factor in a Tertiary Center Intensive Coronary Care Unit. Clin Appl Thromb Hemost 2022; 28:10760296221110879. [PMID: 35866208 PMCID: PMC9310202 DOI: 10.1177/10760296221110879] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce. MATERIAL AND METHOD All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old). RESULTS AND DISCUSSION A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004). CONCLUSION Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization.
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Affiliation(s)
- Moshe Rav Acha
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Turyan
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rivka Farkash
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Feras Bayya
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohammad Karmi
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Fauzi Fadi Shaheen
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kamal Hamayel
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levi
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariella Tvito
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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10
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Levi N, Bongiorni MG, Rav Acha M, Tovia-Brodie O, Kennergren C, Auricchio A, Maggioni AP, Rinaldi CA, Nof E, Ilan M, Blomstrom-Lundqvist C, Deharo JC, Leclercq C, Glikson M, Michowitz Y. Lead fixation mechanism impacts outcome of transvenous lead extraction: Data from the European Lead Extraction ConTRolled Registry. Europace 2021; 24:817-827. [PMID: 34652415 DOI: 10.1093/europace/euab240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/04/2021] [Accepted: 08/26/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS The aims of this study is to characterize the transvenous lead extraction (TLE) population with active (A) compared with passive fixation (PFix) leads and to compare the safety, efficacy, and ease of extracting active fixation (AFix) compared with PFix right atrial (RA) and right ventricular (RV) leads. METHODS AND RESULTS The European Lead Extraction ConTRolled Registry (ELECTRa) was analysed. Patients were divided into three groups; those with only AFix, only PFix, and combined Fix leads. Three outcomes were defined. Difficult extraction, complete radiological, and clinical success. Multivariate model was used to analyse the independent effect of Fix mechanism on these outcomes. The study included 2815 patients, 1456 (51.7%) with only AFix leads, 982 (34.9%) with only PFix leads, and 377 (13.4%) with combined Fix leads. Patients with AFix leads were younger with shorter lead dwelling time. Infection was the leading cause for TLE among the combined Fix group with lowest rates among AFix group. No difference in complications rates was noted between patients with only AFix vs. PFix leads. Overall, there were 1689 RA (1046 AFix and 643 PFix) and 2617 RV leads (1441 AFix and 1176 PFix). Multivariate model demonstrated that PFix is independently associated with more difficult extraction for both RA and RV leads, lower radiological success in the RA but has no effect on clinical success. CONCLUSION Mechanism of Fix impact the ease of TLE of RA and RV leads and rates of complete radiological success in the RA but not clinical success. These findings should be considered during implantation and TLE procedures.
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | | | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | | | | | - Eyal Nof
- Leviev Heart Institute, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Michael Ilan
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | | | - Jean-Claude Deharo
- Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.,Aix Marseille University, C2VN Marseille, France
| | | | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
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11
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Rav Acha M, Rafael A, Keaney JJ, Elitzur Y, Danon A, Shauer A, Taha L, Shechter Y, Bogot NR, Luria D, Ilan M, Singh SM, Mela T, Weisz G, Glikson M, Medina A. The management of cardiac implantable electronic device lead perforations: a multicentre study. Europace 2020; 21:937-943. [PMID: 31157389 DOI: 10.1093/europace/euz120] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/11/2018] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
AIMS Lead perforation is a rare, well-known complication of cardiac implantable electronic device (CIED) implants, whose management is mostly not evidence-based. Main management strategies include conservative approach based on clinical and lead function follow-up vs. routine invasive lead revision approach. This study compared the complications of both strategies by composite endpoint, including recurrent perforation-related symptoms, recurrent pericardial effusion (PEf), lead dysfunction, and device infection during 12 month follow-up. METHODS AND RESULTS Multicentre retrospective analysis, inquiring data from imaging studies, device interrogation, pericardiocentesis, and clinical charts of patients with suspected perforating leads between 2007 and 2014 in five hospitals. All cases were reviewed by electrophysiologist and defined as definite perforations by suggestive symptoms along with lead perforation on imaging, bloody PEf on pericardiocentesis shortly after implant, or right ventricular (RV) lead non-capture along with diaphragmatic stimulation upon bipolar pacing. Clinical outcomes associated with both management approaches were compared, with respect to the composite endpoint. The study included 48 definitive perforation cases: 22 managed conservatively and 26 via lead revision. Conservative management was associated with an increased composite endpoint compared with lead revision (8/22 vs. 1/26; P = 0.007). The dominant complication among the conservative cohort was appearance of cardiac tamponade during follow-up; 5/6 occurring in cases which presented with no or only mild PEf and were treated by antiplatelets/coagulants during or shortly after CIED implantation. CONCLUSION A conservative management of CIED lead perforation is associated with increased complications compared with early lead revision. Lead revision may be the preferred management particularly in patients receiving antiplatelets/coagulants.
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Affiliation(s)
- Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Shmuel Beit 12 Street, Jerusalem 3235, Israel
| | - Allon Rafael
- Cardiac Electrophysiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - John J Keaney
- Cardiac Electrophysiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Yair Elitzur
- Cardiology Department, Hadassah Hospital, Hebrew University, Jerusalem, Israel
| | - Asaf Danon
- Cardiology Department, Montefiore Medical center, New York, USA
| | - Ayelet Shauer
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Louay Taha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Shmuel Beit 12 Street, Jerusalem 3235, Israel
| | - Yonat Shechter
- Cardiology Department, Hadassah Hospital, Hebrew University, Jerusalem, Israel
| | - Naama R Bogot
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Shmuel Beit 12 Street, Jerusalem 3235, Israel
| | - David Luria
- Cardiology Department, Hadassah Hospital, Hebrew University, Jerusalem, Israel
| | - Michael Ilan
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Shmuel Beit 12 Street, Jerusalem 3235, Israel
| | - Sheldon M Singh
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Theofanie Mela
- Cardiac Electrophysiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Giora Weisz
- Cardiology Department, Montefiore Medical center, New York, USA
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Shmuel Beit 12 Street, Jerusalem 3235, Israel
| | - Aharon Medina
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Shmuel Beit 12 Street, Jerusalem 3235, Israel
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12
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Amir T, Ilan M, Fishman E, Michowitz Y, Khalameizer V, Katz A, Glikson M, Medina A, Rav Acha M. "Preventive" pacing in patients with tachy-brady syndrome (TBS): Confirming a common practice. Int J Clin Pract 2020; 74:e13583. [PMID: 32533880 DOI: 10.1111/ijcp.13583] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS Many tachy-brady syndrome (TBS) patients, are implanted a permanent pacemaker (PPM) to allow continuation of anti-arrhythmic drug (AAD) therapy to maintain sinus rhythm. Many of these PPM's are implanted as a preventive measure, in absence of symptomatic bradycardia. Our primary aim was to evaluate pacing use among these patients and find predictors for PPM use. Our secondary aim was to appreciate the portion of these patients who progress to permanent atrial fibrillation (AF). METHODS Retrospective study of TBS patients implanted a PPM as preventive measure, dividing cases into defined categories regarding highest percent atrial and ventricular pacing documented in PPM clinic visits during 3 year follow-up (F/U) period. Patients' baseline characteristics and AAD therapy were compared between cases with a major (>90%) pacing use and cases with <90% pacing use to find predictors for pacing use. Multivariable logistic regression was applied to identify independent variables associated with major pacing use. RESULTS Our study included 119 TBS patients. Most (86.5%) TBS patients had a moderate (>50%) pacing use and 58% had a major pacing use. Significant association was found between pre-implant severe sinus bradycardia (<40 bpm), first degree atrioventricular block and amiodarone treatment to major pacing use on univariate analysis and severe sinus bradycardia was significantly associated with major pacing on multivariate analysis as well. Only minority (16.8%) of TBS patients progressed to permanent AF during the study F/U period. CONCLUSION Our study reveals most TBS patients succeed to maintain sinus rhythm using an AAD with a significant pacing use, suggesting preventive PPM implantation might be advantageous in these cases. Pre-implant severe sinus bradycardia (<40 bpm) is a possible predictor for major pacing use in this population.
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Affiliation(s)
- Teva Amir
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Michael Ilan
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Euvgeny Fishman
- Barzily Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Yoav Michowitz
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Amos Katz
- Barzily Medical Center, Ben-Gurion University, Ashkelon, Israel
- Assuta Medical Center, Beer Sheva, Israel
| | - Michael Glikson
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Aharon Medina
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Moshe Rav Acha
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
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13
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Rav Acha M, Soifer E, Hasin T. Cardiac Implantable Electronic Miniaturized and Micro Devices. Micromachines (Basel) 2020; 11:E902. [PMID: 33003460 PMCID: PMC7600795 DOI: 10.3390/mi11100902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022]
Abstract
Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities ('arrhythmias'), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert for early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients' life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and the termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and the survival of HF patients. Traditionally, these devices are implanted via the venous system ('endovascular') using conductors ('endovascular leads/electrodes') that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection resulting from the lifelong exposure of these leads to bacteria within the venous system. One of the important cardiac innovations in the last decade was the development of a leadless PPM functioning without venous leads, thus circumventing most endovascular PPM-related problems. Leadless PPM's consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, directly implanted into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM's sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices that are designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development. Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities ('arrhythmias'), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients' life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and survival of HF patients. Traditionally, these devices are implanted via the venous system ('endovascular') using conductors ('endovascular leads/electrodes') that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection that result from the lifelong exposure of these leads to bacteria within the venous system. The development of a leadless PPM functioning without venous leads was one of the important cardiac innovations in the last decade, thus circumventing most endovascular PPM-related problems. Leadless PPM's consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, implanted directly into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM's sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development.
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Affiliation(s)
- Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 910000, Israel;
| | - Elina Soifer
- Vectorious Medical Technologies, Tel Aviv 610000, Israel;
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 910000, Israel;
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Davarashvili I, Acha MR, Glikson M, Farkash R, Mazouz B, Butnaru A, Hasin T. Pulmonary Congestion Complicating Atrial Fibrillation Cardioversion. Am J Cardiol 2018; 122:1701-1706. [PMID: 30262403 DOI: 10.1016/j.amjcard.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/05/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
Acute pulmonary congestion (APC) may occur within hours after electrical cardioversion of atrial fibrillation (AF). There is scarce data about its incidence, risk factors, and the outcome. In the present study, data of consecutive patients admitted for first electrical cardioversion for AF between 2007 and 2016 were retrospectively reviewed. APC within the 48 hours following cardioversion was defined as dyspnea and at least one of the following: drop in saturation to <90%, administration of intravenous diuretic or an emergent chest X-ray with new pulmonary congestion. All-cause mortality was determined from the national registry. Total of 1,696 patients had first cardioversion for AF, of whom 66 (3.9%) had APC. In a multivariate logistic regression model independent predictors of APC included (OR [CI], p): older age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02 to 1.08, p = 0.001), rapid ventricular response (OR 1.98, 95% CI 1.17 to 3.34, 0.010), previous heart failure (OR 3.53, 95% CI 2.09 to 5.97, p <0.001), Amiodarone loading (OR 2.38, 95% CI 1.18 to 4.79, p = 0.016) and diabetes mellitus (OR 1.77 95% CI 1.05 to 3.00, p = 0.033). There was no difference in cardioversion success rate (overall 94%). In-hospital mortality was 1.5% within the APC group and 0.5% without (p = 0.301). Patients with APC had higher rate of 6-month readmissions (28.8% vs 18.1% p <0.028). Within a median follow-up of 2.9 years, APC following cardioversion was an independent predictor of overall mortality (hazard ratio 1.73, 95% CI (1.17 to 2.56) p = 0.006). In conclusion, APC occurs in 3.9% of hospitalized patients following electrical AF cardioversion. Risk factors include increased age, diabetes mellitus, heart failure, Amiodarone loading and rapid ventricular response. APC following cardioversion is associated with increased rates of readmissions and mortality.
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Rav Acha M, Corn BW. Revisiting the impact of radiation therapy on cardiac implantable electronic device (CIED) function. J Cardiovasc Electrophysiol 2018; 29:1276-1279. [DOI: 10.1111/jce.13694] [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] [Received: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Moshe Rav Acha
- Cardiology Department, Shaare Tzedek HospitalHebrew University Jerusalem Israel
| | - Ben W. Corn
- Radiation Oncology Department, Shaare Tzedek HospitalTel Aviv University School of Medicine Tel Aviv Israel
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Rav Acha M, Medina A, Rosenmann D, Bogot N, Klutstein MW, Butnaru A, Weisz G. The Importance of Trans-Thoracic Echocardiographic Suprasternal View in the Diagnosis and Treatment Follow-Up of Pulmonary Emboli. Isr Med Assoc J 2017; 19:61-62. [PMID: 28457119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Moshe Rav Acha
- Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Aharon Medina
- Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - David Rosenmann
- Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Naama Bogot
- Department of Radiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Marc W Klutstein
- Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Adi Butnaru
- Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Giora Weisz
- Department of Cardiology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Mansour M, Afzal MR, Gunda S, Pillarisetti J, Heist K, Acha MR, Heard M, Ruskin J, Lakkireddy D. Feasibility of Transseptal Puncture Using a Nonfluoroscopic Catheter Tracking System. Pacing Clin Electrophysiol 2015; 38:791-6. [PMID: 25712806 DOI: 10.1111/pace.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access. METHODS The feasibility of performing TS puncture with MediGuide (MDG) was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation for atrial fibrillation. These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups. RESULTS All patients underwent successful TS puncture. Fluoroscopy time for double TS puncture using the MDG system was significantly lower than the control group (0.48 ± 0.17 minutes vs. 5.9 ± 0.65 minutes; P < 0.0001). No major complications occurred during the procedures in either group. CONCLUSIONS TS puncture can be successfully performed using MDG, and results in significant reduction in radiation exposure.
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Affiliation(s)
- Moussa Mansour
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Muhammad R Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Sampath Gunda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Jayasree Pillarisetti
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Moshe Rav Acha
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jeremy Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
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Acha MR, Keaney JJ, Lubitz SA, Milan DJ, Mansour M, Heist KE, Ptaszek LM, Singh JP, Blendea D, Mela T. Increased perforation risk with an MRI-conditional pacing lead: a single-center study. Pacing Clin Electrophysiol 2014; 38:334-42. [PMID: 25469809 DOI: 10.1111/pace.12550] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 06/18/2014] [Revised: 09/22/2014] [Accepted: 10/20/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been considered contraindicated in patients with cardiac pacemakers (PPMs). Recently, Medtronic (MDT) MRI SureScan PPM (Medtronic Inc., Minneapolis, MN, USA) and leads were introduced into clinical practice in the United States of America. OBJECTIVE To compare MDT CapSureFix 5086 MRI SureScan lead-associated perforation and dislodgement rates with MDT non-MRI SureScan active fixation leads. METHODS We retrospectively analyzed the records of all patients implanted with MDT CapSureFix 5086 MRI SureScan leads as well as all patients implanted with MDT 4076 and 5076 leads at our institution from April 2011 to April 2014. RESULTS Four of 72 patients implanted with MDT CapSureFix 5086 MRI SureScan leads (5.5%) had evidence of lead perforation, necessitating pericardiocentesis in three cases and lead revision in one case. Three of the four perforations were delayed perforations, presenting more than 3 weeks postimplant. Two patients implanted with MDT CapSureFix 5086 MRI SureScan leads (2.8%) had lead dislodgement. Of 420 patients implanted with MDT non-MRI SureScan leads, there were two perforations (0.47%) and four dislodgements (0.9%). There were significantly increased lead perforations associated with MDT CapSureFix 5086 MRI SureScan leads (P = 0.005) and a nonsignificant trend toward increased dislodgements (P = 0.18) when compared with MDT non-MRI SureScan leads. CONCLUSION In contradiction to prior studies, this retrospective study suggests an increased perforation rate with MDT CapSureFix 5086 MRI SureScan leads. Most perforations were delayed perforations, presenting more than 3 weeks postimplant. Higher volume prospective studies with longer follow-up are needed to confirm our findings.
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Affiliation(s)
- Moshe Rav Acha
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
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Rav Acha M, Milan D. Who should receive the subcutaneous implanted defibrillator?: Timing is not right to replace the transvenous implantable cardioverter defibrillator. Circ Arrhythm Electrophysiol 2014; 6:1246-51; discussion 1251. [PMID: 24347600 DOI: 10.1161/circep.113.000445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Moshe Rav Acha
- Massachusetts General Hospital, Cardiac Arrhythmia Service, Boston
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Milan DJ, Acha MR. Recovery of myocardial tissue from extracted leads. Heart Rhythm 2011; 9:405-6. [PMID: 22063082 DOI: 10.1016/j.hrthm.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Indexed: 11/15/2022]
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