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Abumayyaleh M, Dreher TC, Rosenkaimer S, Röger S, Erath JW, Klein N, Kovacs B, Duru F, Saguner AM, El-Battrawy I, Akin I. Sex differences and adherence of patients treated with wearable cardioverter-defibrillator: insights from an international multicenter register. J Cardiovasc Electrophysiol 2022; 33:2243-2249. [PMID: 35930623 DOI: 10.1111/jce.15648] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
AIMS Treatment with the wearable cardioverter defibrillator (WCD) may protect against sudden cardiac death (SCD) as a bridging therapy until a cardioverter-defibrillator may be implanted. We analyzed in a multicenter setting a consecutive patient cohort wearing WCD to explore sex differences. METHODS AND RESULTS We analyzed 708 consecutive patients, 579 (81.8%) from whom were males and 129 (18.2%) females (age, 60.5±14 vs. 61.6±17 years old; p=0.44). While the rate of ischemic cardiomyopathy (ICM) as a cause of prescription of WCD was significantly higher in males as compared to females (42.7% vs. 26.4%; p=0.001), females received it more frequently due to non-ischemic cardiomyopathy (NICM) (55.8% vs. 42.7%); p=0.009). The wear time of WCD was equivalent in both groups (21.1±4.3 hours/days in males vs. 21.5±4.4 hours/days in females; p=0.27; and 62.6±44.3 days in males vs. 56.5±39 days in females; p=0.15). Mortality was comparable in both groups at 2-year-follow-up (6.8% in males vs. 9.7% in females; p=0.55). Appropriate WCD shocks and the incidence of ICD implantations were similar in both groups (2.4% in males vs. 3.9% in females; p=0.07) (35.1% in males vs. 31.8% in females; p=0.37), respectively. In age tertile analysis, compliance was observed more in 73-91 years old group as compared to 14-51 years old group (87.8% vs. 68.3%; p<0.001). CONCLUSION Compliance for wearing WCD was excellent regardless of sex. Furthermore, mortality and the incidence of ICD implantations were comparable in both sexes. Appropriate WCD shocks were similar in both sexes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Tobias C Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Susanne Röger
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Julia W Erath
- Department of Cardiology/Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University, Frankfurt a. M., Germany
| | - Norbert Klein
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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El-Battrawy I, Kovacs B, Dreher TC, Klein N, Rosenkaimer S, Röger S, Kuschyk J, Saguner AM, Kowitz J, Erath JW, Duru F, Akin I. Real life experience with the wearable cardioverter-defibrillator in an international multicenter Registry. Sci Rep 2022; 12:3203. [PMID: 35217697 PMCID: PMC8881447 DOI: 10.1038/s41598-022-06007-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/22/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
Patients at high risk for sudden cardiac death (SCD) may benefit from wearable cardioverter defibrillators (WCD) by avoiding immediate implantable cardioverter defibrillator (ICD) implantation. Different factors play an important role including patient selection, compliance and optimal drug treatment. We aimed to present real world data from 4 centers from Germany and Switzerland. Between 04/2012 and 03/2019, 708 patients were included in this registry. Patients were followed up over a mean time of 28 ± 35.5 months. Outcome data including gender differences and different etiologies of cardiomyopathy were analyzed. Out of 708 patients (81.8% males, mean age 61.0 ± 14.6), 44.6% of patients had non-ischemic cardiomyopathy, 39.8% ischemic cardiomyopathy, 7.9% myocarditis, 5.4% prior need for ICD explantation and 2.1% channelopathy. The mean wear time of WCD was 21.2 ± 4.3 h per day. In 46% of patients, left ventricular ejection fraction (LVEF) was > 35% during follow-up. The younger the patient was, the higher the LVEF and the lower the wear hours per day were. The total shock rate during follow-up was 2.7%. Whereas an appropriate WCD shock was documented in 16 patients (2.2%), 3 patients received an inappropriate ICD shock (0.5%). During follow-up, implantation of a cardiac implantable electronic device was carried out in 34.5% of patients. When comparing German patients (n = 516) to Swiss patients (n = 192), Swiss patients presented with longer wear days (70.72 ± 49.47 days versus 58.06 ± 40.45 days; p = 0.001) and a higher ICD implantation rate compared to German patients (48.4% versus 29.3%; p = 0.001), although LVEF at follow-up was similar between both groups. Young age is a negative independent predictor for the compliance in this large registry. The most common indication for WCD was non-ischemic cardiomyopathy followed by ischemic cardiomyopathy. The compliance rate was generally high with a decrease of wear hours per day at younger age. Slight differences were found between Swiss and German patients, which might be related to differences in mentality for ICD implantation.
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Affiliation(s)
- Ibrahim El-Battrawy
- grid.5570.70000 0004 0490 981XBergmannsheil University Medical Center, Ruhr University Bochum, Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Boldizsar Kovacs
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tobias C. Dreher
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Norbert Klein
- grid.470221.20000 0001 0690 7373Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Delitzscher Straße 141, 04129 Leipzig, Germany
| | | | - Susanne Röger
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Ardan Muammer Saguner
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jacqueline Kowitz
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Julia W. Erath
- grid.7839.50000 0004 1936 9721Department of Cardiology, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Firat Duru
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ibrahim Akin
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
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Tülümen E, Rudic B, Ringlage H, Hohneck A, Röger S, Liebe V, Kuschyk J, Overhoff D, Budjan J, Akin I, Borggrefe M, Papavassiliu T. Extent of peri-infarct scar on late gadolinium enhancement cardiac magnetic resonance imaging and outcome in patients with ischemic cardiomyopathy. Heart Rhythm 2021; 18:954-961. [PMID: 33515714 DOI: 10.1016/j.hrthm.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/17/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Only a minority of patients who receive an implantable cardioverter-defibrillator (ICD) on the basis of left ventricular ejection fraction receive appropriate ICD therapy. Peri-infarct scar zone assessed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a possible substrate for ventricular tachyarrhytmias (VTAs). OBJECTIVE The aim of our prospective study was to determine whether LGE-CMR parameters can predict the occurrence of VTA in patients with ischemic cardiomyopathy (ICM). METHODS Two hundred sixteen patients with ICM underwent CMR imaging before primary or secondary ICD implantation and were prospectively followed. We assessed CMR indices and CMR scar characteristics (infarct core and peri-infarct zone) to predict outcome and VTAs. RESULTS Patients were followed up for 1497 days (interquartile range 697-2237 days). Forty-seven patients (21%) received appropriate therapy during follow-up. Patients with appropriate ICD therapy had smaller core scar (31.5% ± 8.5% vs 36.8% ± 8.9%; P = .0004) but larger peri-infarct scar (12.4% ± 2.6% vs 10.5% ± 2.9%; P = .0001) than did patients without appropriate therapy. In multivariate Cox regression analysis, peri-infarct scar (hazard ratio 1.15; 95% confidence interval 1.07-1.24; P = .0001) was independently and significantly associated with VTAs whereas left ventricular ejection fraction, right ventricular ejection fraction, core scar, and left atrial ejection fraction were not. CONCLUSION Scar extent of peri-infarct border zone was significantly associated with appropriate ICD therapy. Thus, LGE-CMR parameters can identify a subgroup of patients with ICM and an increased risk of life-threatening VTAs.
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Affiliation(s)
- Erol Tülümen
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
| | - Boris Rudic
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Hannah Ringlage
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Anna Hohneck
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Susanne Röger
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Volker Liebe
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Daniel Overhoff
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Johannes Budjan
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Martin Borggrefe
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
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Rudic B, Tülümen E, Fastenrath F, Röger S, Goranova D, Akin I, Borggrefe M, Kuschyk J. Incidence, mechanisms, and clinical impact of inappropriate shocks in patients with a subcutaneous defibrillator. Europace 2020; 22:761-768. [DOI: 10.1093/europace/euaa026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/23/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Inappropriate shocks (IAS) remain a challenge for patients and physicians after implantation of the subcutaneous implantable cardioverter-defibrillator (S-ICD). The aims were to assess and characterize different patterns of IAS.
Methods and results
Two hundred and thirty-nine patients were implanted with an S-ICD between 2010 and 2018 for primary and secondary prevention. Follow-up data of at least 6 months were analysed. During a mean follow-up of 34.9 ± 16.0 months, a total of 73 shocks occurred in 38 patients (6%). Forty-three (59%) shocks were considered appropriate due to ventricular tachycardia/ventricular fibrillation, while 30 (41%) were inappropriate and occurred in 19 patients (8%). Myopotentials/noise was the most frequent cause of inappropriate shocks (n = 8), followed by T-wave oversensing (n = 6) and undersensing of the QRS, resulting in adaptation of the automatic gain control and inappropriate shock (n = 5). Seventy-four percent of all IAS occurred on the primary vector, while no IAS occurred on the alternate vector. In seven of eight patients (88%), IAS related to myopotentials have occurred on the primary sensing vector. Multivariate analysis identified taller patients, primary sensing vector and first-generation S-ICD device as predictors for IAS. SMART pass effectively reduced the occurrence of IAS in the second-generation S-ICD system.
Conclusion
Inappropriate therapies are less frequently observed on the alternate vector. The primary vector seems to be unfavourable with regard to oversensing caused by myopotentials. Inappropriate shocks were associated with an increased rate of rehospitalization but not mortality. These observations have implications for the prevention of inappropriate S-ICD shocks.
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Affiliation(s)
- Boris Rudic
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Fabian Fastenrath
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Diana Goranova
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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5
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Becher T, Seiler L, Rudic B, Röger S, Tülümen E, Liebe V, Kuschyk J, Trinkmann F, Michels J, Weiss C, Akin I, Kälsch T, Borggrefe M, Stach K. Cardioprotective Effects of Dronedarone Mediated by the Influence on the Expression of Urokinase-Type Plasminogen Activator Receptor. J Vasc Res 2019; 56:92-96. [PMID: 31079118 DOI: 10.1159/000499526] [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: 05/09/2018] [Accepted: 03/08/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Dronedarone is a multichannel-blocking antiarrhythmic drug for the treatment of atrial fibrillation. Observational data hypothesized a cardioprotective effect. In an in vitro endothelial cell-platelet model, we evaluated the molecular atheroprotective effects of dronedarone. METHODS Following a 24-h incubation of human umbilical vein endothelial cells (HUVECs) with dronedarone (concentration 50, 100, and 150 ng/mL), they were then stimulated for 1 h with lipopolysaccharide (LPS) and were subsequently incubated in direct contact with thrombin-activated platelets. After incubation, the expression of CD40L and CD62P on platelets, and the expression of ICAM-1, VCAM-1, urokinase-type plasminogen activator receptor (uPAR), and membrane type 1 matrix metalloproteinase (MT1-MMP) on endothelial cells were measured by flow cytometry. RESULTS Preincubation with 150 ng/mL of dronedarone reduced the expression of uPAR on endothelial cells after proinflammatory stimulation with LPS and also by direct endothelial contact with activated platelets (p = 0.0038). In contrast, the expression of CD40L and CD62P on platelets after proinflammatory stimulation with thrombin was significantly increased through direct preincubation with 50/100/150 ng/mL of dronedarone. However, dronedarone had no effects on the expression of MT1-MMP and ICAM-1 in HUVECs. CONCLUSION In this in vitro analysis, dronedarone directly increased platelet activation but showed significant direct effects on endothelial cells and indirect effects on platelets on selected markers of atherosclerosis.
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Affiliation(s)
- Tobias Becher
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lea Seiler
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Boris Rudic
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre of Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre of Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre of Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Trinkmann
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julia Michels
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics, University Medical Centre Mannheim, Medical Faculty Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre of Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thorsten Kälsch
- University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre of Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- First Department of Medicine, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany, .,DZHK (German Centre of Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany,
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6
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Anker SD, Borggrefe M, Neuser H, Ohlow MA, Röger S, Goette A, Remppis BA, Kuck KH, Najarian KB, Gutterman DD, Rousso B, Burkhoff D, Hasenfuss G. Cardiac contractility modulation improves long-term survival and hospitalizations in heart failure with reduced ejection fraction. Eur J Heart Fail 2019; 21:1103-1113. [PMID: 30652394 DOI: 10.1002/ejhf.1374] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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: 08/06/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiac contractility modulation (CCM) improves symptoms and exercise tolerance and reduces heart failure (HF) hospitalizations over 6-month follow-up in patients with New York Heart Association (NYHA) class III or IV symptoms, QRS < 130 ms and 25% ≤ left ventricular ejection fraction (LVEF) ≤ 45% (FIX-HF-5C study). The current prospective registry study (CCM-REG) aimed to assess the longer-term impact of CCM on hospitalizations and mortality in real-world experience in this same population. METHODS AND RESULTS A total of 140 patients with 25% ≤ LVEF ≤ 45% receiving CCM therapy (CCM-REG25-45 ) for clinical indications were included. Cardiovascular and HF hospitalizations, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and NYHA class were assessed over 2 years. Mortality was tracked through 3 years and compared with predictions by the Seattle Heart Failure Model (SHFM). A separate analysis was performed on patients with 35% ≤ LVEF ≤ 45% (CCM-REG35-45 ) and 25% ≤ LVEF < 35% (CCM-REG25-34 ). Hospitalizations decreased by 75% (from 1.2/patient-year the year before, to 0.35/patient-year during the 2 years following CCM, P < 0.0001) in CCM-REG25-45 and by a similar amount in CCM-REG35-45 (P < 0.0001) and CCM-REG25-34 . MLHFQ and NYHA class improved in all three cohorts, with progressive improvements over time (P < 0.002). Three-year survival in CCM-REG25-45 (82.8%) and CCM-REG24-34 (79.4%) were similar to those predicted by SHFM (76.7%, P = 0.16; 78.0%, P = 0.81, respectively) and was better than predicted in CCM-REG35-45 (88.0% vs. 74.7%, P = 0.046). CONCLUSION In real-world experience, CCM produces results similar to those of previous studies in subjects with 25% ≤ LVEF ≤ 45% and QRS < 130 ms; cardiovascular and HF hospitalizations are reduced and MLHFQ and NYHA class are improved. Overall mortality was comparable to that predicted by the SHFM but was lower than predicted in patients with 35% ≤ LVEF ≤ 45%.
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Affiliation(s)
- Stefan D Anker
- Division of Cardiology and Metabolism; Department of Cardiology (CVK; and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology and The German Center for Cardiovascular Research (DZHK), University Medicine Göttingen (UMG), Göttingen, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Hans Neuser
- HELIOS Vogtland-Klinikum Plauen, Klinik für Innere Medizin II/Kardiologie, Pneumologie und Angiologie, Plauen, Germany
| | | | - Susanne Röger
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Andreas Goette
- St. Vincenz Krankenhaus Paderborn, Paderborn, Germany.,Working Group of Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | | | | | | | | | | | - Gerd Hasenfuss
- Department of Cardiology and Pneumology and The German Center for Cardiovascular Research (DZHK), University Medicine Göttingen (UMG), Göttingen, Germany
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7
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Röger S, Rudic B, Akin I, Shchetynska-Marinova T, Fastenrath F, Tülümen E, Liebe V, El-Battrawy I, Baumann S, Kuschyk J, Borggrefe M. Long-term results of combined cardiac contractility modulation and subcutaneous defibrillator therapy in patients with heart failure and reduced ejection fraction. Clin Cardiol 2018; 41:518-524. [PMID: 29697870 PMCID: PMC5947638 DOI: 10.1002/clc.22919] [Citation(s) in RCA: 11] [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: 11/21/2017] [Revised: 01/28/2018] [Accepted: 02/04/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cardiac contractility modulation (CCM) is an electrical-device therapy for patients with heart failure with reduced ejection fraction (HFrEF). Patients with left ventricular ejection fraction (LVEF) ≤35% also have indication for an implantable cardioverter-defibrillator (ICD), and in some cases subcutaneous ICD (S-ICD) is selected. HYPOTHESIS CCM and S-ICD can be combined to work efficaciously and safely. METHODS We report on 20 patients with HFrEF and LVEF ≤35% who received CCM and S-ICD. To exclude device interference, patients received intraoperative crosstalk testing, S-ICD testing, and bicycle exercise testing while CCM was activated. Clinical and QOL measures before CCM activation and at last follow-up were analyzed. S-ICD performance was evaluated while both CCM and S-ICD were active. RESULTS Mean follow-up was 34.3 months. NYHA class improved from 2.9 ± 0.4 to 2.1 ± 0.7 (P < 0.0001), Minnesota Living With Heart Failure Questionnaire score improved from 50.2 ± 23.7 to 29.6 ± 22.8 points (P < 0.0001), and LVEF improved from 24.4% ± 8.1% to 30.9% ± 9.6% (P = 0.002). Mean follow-up time with both devices active was 22 months. Three patients experienced a total of 6 episodes of sustained ventricular tachycardia, all successfully treated with first ICD shock. One case received an inappropriate shock unrelated to the concomitant CCM. One patient received an LVAD, so CCM and S-ICD were discontinued. CONCLUSIONS CCM and S-ICD can be successfully combined in patients with HFrEF. S-ICD and CCM remain efficacious when used together, with no interference affecting their function.
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Affiliation(s)
- Susanne Röger
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Boris Rudic
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Tetyana Shchetynska-Marinova
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Fabian Fastenrath
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Stefan Baumann
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
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8
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Röger S, Rosenkaimer SL, Hohneck A, Lang S, El-Battrawy I, Rudic B, Tülümen E, Stach K, Kuschyk J, Akin I, Borggrefe M. Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting. BMC Cardiovasc Disord 2018; 18:52. [PMID: 29544442 PMCID: PMC5856002 DOI: 10.1186/s12872-018-0790-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/08/2018] [Indexed: 12/15/2022] Open
Abstract
Background The wearable cardioverter-defibrillator (WCD) has emerged as a valuable tool to temporarily protect patients at risk for sudden cardiac death (SCD). The aim of this study was to determine the value of the WCD for therapy optimization of heart failure patients. Methods One hundred five consecutive patients that received WCD between 4/2012 and 9/2016 were included in the study. All patients were followed for clinical outcome and echocardiographic parameters during WCD therapy and had continued follow-up after WCD therapy, irrespective of subsequent implantable cardioverter-defibrillator (ICD) implantation. Results The most common indication for WCD were newly diagnosed ischemic (ICM) or non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction (LVEF) ≤35%. Mean WCD wear time was 68.8 ± 50.4 days with a mean daily use of 21.5 ± 3.5 h. Five patients (4.8%) received a total of five appropriate WCD shocks. During WCD wear, patients with ICM and NICM showed significant improvement in LVEF, reducing the proportion of patients with a need for primary preventive ICD implantation to 54.8% (ICM) and 48.8% (NICM). An ICD was finally implanted in 51.4% of the study patients (24 trans-venous ICDs, 30 subcutaneous ICDs). After discontinuation of WCD therapy, all patients were followed for a mean of 18.6 ± 12.3 months. 5.6% of patients with implanted ICDs received appropriate therapies. No patient with subcutaneous ICD needed change to a trans-venous device. None of the patients without an implanted ICD suffered from ventricular tachyarrhythmias and no patient died suddenly. In patients with NICM a significant LVEF improvement was observed during long-term follow-up (from 34.8 ± 11.1% to 41.0 ± 10.2%). Conclusions WCD therapy successfully bridged all patients to either LVEF recovery or ICD implantation. Following WCD, ICD implantation could be avoided in almost half of the patients. In selected patients, prolongation of WCD therapy beyond 3 months might further prevent unnecessary ICD implantation. The WCD as an external monitoring system contributed important information to optimize device selection in patients that needed ICD implantation.
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Affiliation(s)
- Susanne Röger
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| | - Stefanie L Rosenkaimer
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Anna Hohneck
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Boris Rudic
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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9
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Rudic B, Tülümen E, Berlin V, Röger S, Stach K, Liebe V, El-Battrawy I, Dösch C, Papavassiliu T, Akin I, Borggrefe M, Kuschyk J. Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long-Term Follow-Up. J Am Heart Assoc 2017; 6:JAHA.117.006265. [PMID: 29042423 PMCID: PMC5721842 DOI: 10.1161/jaha.117.006265] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 11/24/2022]
Abstract
Background Up to 40% of patients with transvenous implantable cardioverter‐defibrillator (ICD) experience lead‐associated complications and may suffer from high complication rates when lead extraction is indicated. Subcutaneous ICD may represent a feasible alternative; however, the efficacy of the subcutaneous ICD in the detection and treatment of ventricular arrhythmias in patients with hereditary arrhythmia syndromes has not been fully evaluated. Methods and Results Patients with primary hereditary arrhythmia syndromes who fulfilled indication for defibrillator placement were eligible for enrollment. Between 2010 and 2016, 62 consecutive patients with primary hereditary arrhythmia syndromes, without indication for antibradycardia therapy, were enrolled in the study. Mean follow‐up was 31.0±14.2 months. The study cohort comprised of 24 patients with Brugada syndrome, 17 with idiopathic ventricular fibrillation, 6 with long‐QT syndrome, 1 with short‐QT syndrome, 3 with catecholaminergic polymorphic ventricular tachycardia, 8 with hypertrophic cardiomyopathy, and 3 with arrhythmogenic right ventricular cardiomyopathy. Thirty‐nine patients were implanted for secondary prevention. Twenty‐two patients had a previous transvenous ICD implanted, but required revision because of infection or lead defects. A total of 20 spontaneous ventricular tachyarrhythmias requiring shock intervention occurred in 10 patients during follow‐up. All episodes were terminated within the first ICD shock delivery with 80 J. Two patients had inappropriate therapies caused by oversensing following an uneventful implantation. No pocket‐site infections and no premature revisions have occurred during follow‐up. Conclusions Our study supports the use of the subcutaneous ICD for both secondary and primary prevention of sudden cardiac death as a reliable alternative to the conventional transvenous ICD.
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Affiliation(s)
- Boris Rudic
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany .,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Veronika Berlin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Volker Liebe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christina Dösch
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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10
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El-Battrawy I, Ansari U, Lang S, Behnes M, Schramm K, Fastner C, Zhou X, Kuschyk J, Tülümen E, Röger S, Borggrefe M, Akin I. Impact and management of left ventricular function on the prognosis of Takotsubo syndrome. Eur J Clin Invest 2017; 47:477-485. [PMID: 28517022 DOI: 10.1111/eci.12768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early research has proposed that patients with Takotsubo syndrome (TTS) could have a higher mortality rate than the general population. Our study was conducted to determine the short- and long-term outcome of TTS patients associated with a significantly compromised left ventricular function on hospital admission. MATERIALS AND METHODS Our institutional database constituted a collective of 112 patients diagnosed with TTS between 2003 and 2015. The patients were classified into two groups based on the left ventricular ejection fraction (LVEF), with those presenting with a LVEF > 35% on admission categorized into one group (n = 65, 58%) and those presenting with LVEF ≤ 35% (n=47, 42%) categorized into another group. The endpoint was the all-cause of mortality over a mean follow-up of 1529 ± 1121 days. RESULTS Preliminary results indicated that patients with an EF ≤ 35% had a significantly greater risk of developing life-threatening arrhythmias, and were much more likely to suffer from cardiogenic shock. Patients often required varying forms of mechanical respiratory support. The in-hospital mortality, 30-day mortality, 1-year mortality and ongoing long-term mortality was significantly higher in TTS patients with an EF ≤ 35%. In a multivariate Cox regression analysis, an EF ≤ 35% (HR 3·3, 95% CI: 1·2-9·2, P < 0·05) was identified as a strong independent predictor of the primary endpoint. CONCLUSIONS In-hospital events as well as short- and long-term mortality rates among TTS patients diagnosed with a significantly reduced LVEF on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high risk TTS patients.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (GermanCenter for Cardiovascular Research), Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (GermanCenter for Cardiovascular Research), Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Katja Schramm
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Christian Fastner
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (GermanCenter for Cardiovascular Research), Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Susanne Röger
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (GermanCenter for Cardiovascular Research), Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (GermanCenter for Cardiovascular Research), Mannheim, Germany
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11
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Kuschyk J, Kloppe A, Schmidt-Schweda S, Bonnemeier H, Röger S. Cardiac Contractility Modulation: A Technical Guide for Device Implantation. Rev Cardiovasc Med 2017; 18:1-13. [DOI: 10.3909/ricm0825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Rudic B, Chaykovskaya M, Tsyganov A, Kalinin V, Tülümen E, Papavassiliu T, Dösch C, Liebe V, Kuschyk J, Röger S, El-Battrawy I, Akin I, Yakovleva M, Zaklyazminskaya E, Shestak A, Kim S, Chmelevsky M, Borggrefe M. Simultaneous Non-Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms. J Am Heart Assoc 2016; 5:JAHA.116.004095. [PMID: 27930354 PMCID: PMC5210320 DOI: 10.1161/jaha.116.004095] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The underlying mechanisms of Brugada syndrome (BrS) are not completely understood. Recent studies provided evidence that the electrophysiological substrate, leading to electrocardiogram abnormalities and/or ventricular arrhythmias, is located in the right ventricular outflow tract (RVOT). The purpose of this study was to examine abnormalities of epicardial and endocardial local unipolar electrograms by simultaneous noninvasive mapping in patients with BrS. Methods and Results Local epicardial and endocardial unipolar electrograms were analyzed using a novel noninvasive epi‐ and endocardial electrophysiology system (NEEES) in 12 patients with BrS and 6 with right bundle branch block for comparison. Fifteen normal subjects composed the control group. Observed depolarization abnormalities included fragmented electrograms in the anatomical area of RVOT endocardially and epicardially, significantly prolonged activation time in the RVOT endocardium (65±20 vs 38±13 ms in controls; P=0.008), prolongation of the activation‐recovery interval in the RVOT epicardium (281±34 vs 247±26 ms in controls; P=0.002). Repolarization abnormalities included a larger area of ST‐segment elevation >2 mV and T‐wave inversions. Negative voltage gradient (−2.5 to −6.0 mV) between epicardium and endocardium of the RVOT was observed in 8 of 12 BrS patients, not present in patients with right bundle branch block or in controls. Conclusions Abnormalities of epicardial and endocardial electrograms associated with depolarization and repolarization properties were found using NEEES exclusively in the RVOT of BrS patients. These findings support both, depolarization and repolarization abnormalities, being operative at the same time in patients with BrS.
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Affiliation(s)
- Boris Rudic
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany .,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | | | - Alexey Tsyganov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | | | - Erol Tülümen
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christina Dösch
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Volker Liebe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | | | - Elena Zaklyazminskaya
- Petrovsky National Research Center of Surgery, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - Anna Shestak
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Stanislav Kim
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | | | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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13
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Röger S, Said S, Kloppe A, Lawo T, Emig U, Rousso B, Gutterman D, Borggrefe M, Kuschyk J. Cardiac contractility modulation in heart failure patients: Randomized comparison of signal delivery through one vs. two ventricular leads. J Cardiol 2016; 69:326-332. [PMID: 27590412 DOI: 10.1016/j.jjcc.2016.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/03/2016] [Revised: 06/11/2016] [Accepted: 06/16/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac contractility modulation (CCM) is an electrical stimulation treatment for symptomatic heart failure (HF) patients. The procedure involves implantation of two ventricular leads for delivery of CCM impulses. The purpose of this study is to compare the efficacy and safety of CCM when the signal is delivered through one vs. two ventricular leads. METHODS This prospective blinded randomized trial enrolled 48 patients. Eligible subjects had symptoms despite optimal HF medications, left ventricular ejection fraction <40% and peakVO2≥9ml O2/kg/min. All patients received a CCM system with two ventricular leads, and were randomized to CCM active through both or just one ventricular lead; 25 patients were randomized to receive signal delivery through two leads (Group A) and 23 patients to signal delivery through one lead (Group B). The study compared the mean changes from baseline to 6 months follow-up in peakVO2, New York Heart Association (NYHA) classification, and quality of life (by MLWHFQ). RESULTS Following 6 months, similar and significant (p<0.05) improvements from baseline in NYHA (-0.7±0.5 vs. -0.9±0.7) and MLWHFQ (-14±20 vs. -16±22) were observed in Group A and in Group B. PeakVO2 showed improvement trends in both groups (0.34±1.52 vs. 0.10±2.21ml/kg/min; p=ns). No patient died. Serious adverse event rates (20 events in 10 subjects) were not different between groups. No statistically significant difference was found in any of the study endpoints. CONCLUSIONS The efficacy and safety of CCM in this study were similar when the signal was delivered through either one or two ventricular leads. These results support the potential use of a single ventricular lead for delivery of CCM.
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Affiliation(s)
- Susanne Röger
- Mannheim University Hospital, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
| | - Samir Said
- Magdeburg University Hospital, Magdeburg, Germany
| | - Axel Kloppe
- University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | | | - Ulf Emig
- Helios Klinikum Meiningen Medical Clinic, Meiningen, Germany
| | | | | | - Martin Borggrefe
- Mannheim University Hospital, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Jürgen Kuschyk
- Mannheim University Hospital, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
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14
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Becher T, El-Battrawy I, Baumann S, Fastner C, Behnes M, Loßnitzer D, Elmas E, Hoffmann U, Papavassiliu T, Kuschyk J, Dösch C, Röger S, Hillenbrand D, Schramm K, Borggrefe M, Akin I. Characteristics and long-term outcome of right ventricular involvement in Takotsubo cardiomyopathy. Int J Cardiol 2016; 220:371-5. [PMID: 27390957 DOI: 10.1016/j.ijcard.2016.06.240] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 06/08/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy (SCM) resembles a reversible cardiomyopathy that is characterized by localized wall motion abnormalities in the absence of stenotic coronary vascular disease. Patients typically present with apical ballooning of the left ventricle (LV), however the right ventricle (RV) is also affected in up to 50.0% of patients. Long-term prognosis of classical SCM resembles that of patients after ST elevation myocardial infarction. Data on long-term prognosis of biventricular compared to classical SCM is controversial. The aim of this study was therefore to analyze patients with biventricular SCM regarding in-hospital outcome and long-term prognosis. MATERIALS AND METHODS 114 consecutive patients with SCM were retrospectively analyzed. 88 patients presented with classical SCM, 26 patients (22.8%) were diagnosed with biventricular SCM. Follow-up was conducted for a total of 4.4years. Mean age was 67.1years with 83.3% of patients being female. The primary endpoint was a composite of all-cause mortality, recurrence of SCM and re-hospitalization due to heart failure. RESULTS Although patients with biventricular SCM presented with a tendency towards an increased rate of cardiogenic shock (30.8% vs. 15.9%; p=0.09) and significantly more usage of inotropic support upon hospital admission (34.6% vs. 13.6%; p=0.01), there was no difference concerning the primary endpoint in both groups (50.0% vs. 44.3%; p=0.31). Furthermore, there was no difference in mortality both in-hospital (7.7% vs. 7.9%; p=0.66) and during long-term follow-up (27.3% vs. 23.1%; p=0.46). CONCLUSION Patients with biventricular SCM have the same in-hospital and long-term outcome compared to classical SCM.
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Affiliation(s)
- Tobias Becher
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany.
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Stefan Baumann
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Christian Fastner
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Dirk Loßnitzer
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Elif Elmas
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ursula Hoffmann
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Christina Dösch
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Susanne Röger
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Dennis Hillenbrand
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Katja Schramm
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Germany, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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Kuschyk J, Stach K, Tülümen E, Rudic B, Liebe V, Schimpf R, Borggrefe M, Röger S. Subcutaneous implantable cardioverter-defibrillator: First single-center experience with other cardiac implantable electronic devices. Heart Rhythm 2015; 12:2230-8. [DOI: 10.1016/j.hrthm.2015.06.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Indexed: 11/28/2022]
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Röger S, Borggrefe M, Kuschyk J. Heart Failure With Reduced Ejection Fraction And A Narrow QRS Complex: Combination Of A Subcutaneous Defibrillator With Cardiac Contractility Modulation. J Atr Fibrillation 2015; 8:1081. [PMID: 27957197 DOI: 10.4022/jafib.1081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/09/2015] [Accepted: 08/26/2015] [Indexed: 11/10/2022]
Abstract
Cardiac contractility modulation (CCM) is a relatively new electrical therapy for heart failure patients with reduced ejection fraction. The majority of patients eligible for CCM will also need an implantable cardioverter-defibrillator (ICD). To-date, three pacing electrodes are mandatory for CCM therapy because the current CCM signal delivery algorithm requires sequential intracardiac sensing of a p-wave, followed by appropriately timed ventricular activation by the two ventricular septal leads. As there is no device combining CCM with ICD functions, most CCM patients will need multiple intracardiac electrodes, which increase the cumulative risk for complications such as systemic infections, thrombosis of central venous lines, insulation failures or lead fractures. The long-term complications associated with trans-venous ICD leads have led to the development of a totally subcutaneous implantable cardioverter-defibrillator (S-ICD). In this essay the two technologies CCM and S-ICD are reviewed. Additionally, we present their successful combination on the basis of a case report on the first patient receiving both devices.
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Affiliation(s)
- Susanne Röger
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany
| | - Martin Borggrefe
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Jürgen Kuschyk
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
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Kuschyk J, Röger S, Fastner C, Behnes M, Akin I. Subcutaneous ICD in anatomical challenging cases. Eur Rev Med Pharmacol Sci 2015; 19:3140-3141. [PMID: 26400513] [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: 06/05/2023]
Affiliation(s)
- J Kuschyk
- First Department of Internal Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.
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Kuschyk J, Rudic B, Akin I, Borggrefe M, Röger S. [The subcutaneous cardioverter-defibrillator: When less is more]. Herzschrittmacherther Elektrophysiol 2015; 26:123-8. [PMID: 26058997 DOI: 10.1007/s00399-015-0378-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In the last few decades, defibrillator therapy has revolutionized treatment of patients at risk for sudden cardiac death. Multiple clinical trials have shown the benefit of implantable cardioverter-defibrillators (ICD) for primary and secondary prevention of sudden cardiac death. Being an entirely subcutaneous system, the S-ICD® avoids important periprocedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (TV-ICD) systems as well as the need for fluoroscopy during implant surgery. METHODS AND RESULTS In patients with challenging anatomic conditions or after infection, the S-ICD® might be reasonable. In multicenter studies and registries efficacy and safety of the S-ICD® was equal or better to transvenous implantable defibrillators. The cardiac rhythm is detected by the use of 1 of the 3 potential vectors. The S-ICD® automatically selects the most suitable vector for rhythm detection. If ventricular tachyarrhythmia is detected, the device is able to deliver up to five shocks of 80 J, while postshock pacing is available at 50 bpm for 30 s. The implantation technique is different from that of conventional ICDs, but easily learnable by experienced cardiologists. Initially observed hurdles (e.g., inappropriate shocks or infections) have been overcome by standardized implantation techniques, operator learning curves, and modification of algorithms. CONCLUSIONS The S-ICD® predominately might be suitable in all patients with ICD indication except patients with pacing or cardiac resynchronization therapy (CRT) indication, ventricular tachycardia < 170 bpm, negative screening, or in the occasional patient whose arrhythmia might be suppressed by overdrive pacing. The system received CE certification in 2009 and was approved by the FDA in 2012. Currently, in Germany the S-ICD® has been integrated into the DRG system and can be reimbursed as a single chamber ICD.
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Affiliation(s)
- J Kuschyk
- Deutsches Zentrum für Herz- Kreislaufforschung (DZHK) e.G., Universitätsmedizin Mannheim, I. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland,
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Röger S, Michels J, Heggemann F, Stach K, Rousso B, Borggrefe M, Kuschyk J. Long term impact of cardiac contractility modulation on QRS duration. J Electrocardiol 2014; 47:936-40. [PMID: 25201417 DOI: 10.1016/j.jelectrocard.2014.08.011] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Cardiac contractility modulation (CCM) is an implantable device treatment for heart failure with reduced ejection fraction. CCM therapy improves patient functional status but its effect on intra-ventricular conduction remains unknown. METHODS 70 patients treated with CCM between 12/2002 and 5/2013 had 12-vector-ECG recordings made at baseline and final follow-up visits. QRS complex duration was measured at each time point. RESULTS Mean follow-up was 2.8 years. Mean QRS duration was unchanged from baseline (112.0 ms) to last follow up (112.9 ms, p=n.s.). These results are strikingly different from comparative published data of several studies with heart failure patients without CCM, consistently indicating an increase in QRS duration (6.0-23.4 ms) over a similar time period. CONCLUSIONS CCM prevents chronic ventricular depolarization delay that occurs in heart failure and that is associated with poorer outcomes. This supports the safety of long-term CCM therapy and suggests a possible long-term benefit in maintaining QRS duration.
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Affiliation(s)
- Susanne Röger
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
| | - Julia Michels
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Felix Heggemann
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Ksenija Stach
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | | | - Martin Borggrefe
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
| | - Jürgen Kuschyk
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany
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Bölke E, Röger S, Gripp S, Budach W, Hermsen D, Steinbach G. S-100 Protein Level and Radiation Induced Brain Injury. Clin Oncol (R Coll Radiol) 2007. [DOI: 10.1016/j.clon.2007.01.341] [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: 10/23/2022]
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Harder S, Baas H, Röger S, Demisch L. PK-PD-Relationship of Apomorphine in Patients with Parkinson's Disease. Clin Pharmacol Ther 1996. [DOI: 10.1038/sj.clpt.1996.327] [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: 11/09/2022]
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