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Misra S, Swayampakala K, Rajwani A, Davenport E, Fedor J, Saxonhouse S, Holshouser J, Patel N, Thompson J, Beaty E, Jain M, Powell B, Mehta R. Outcomes of an expedited same-day discharge protocol following cardiac implantable electronic device (CIED) implantation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01734-w. [PMID: 38194120 DOI: 10.1007/s10840-024-01734-w] [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: 07/31/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND With increasing constraints on healthcare resources, greater attention is being focused on improved resource utilization. Prior studies have demonstrated safety of same-day discharge following CIED implantation but are limited by vague protocols with long observation periods. In this study, we evaluate the safety of an expedited 2 hour same-day discharge protocol following CIED implantation. METHODS Patients undergoing CIED implantation at three centers between 2015 and 2021 were included. Procedural, demographic, and adverse event data were abstracted from the electronic health record. Patients were divided into same-day discharge (SDD) and delayed discharge (DD) cohorts. The primary outcome was complications including lead malfunction requiring revision, pneumothorax, hemothorax, lead dislodgement, lead perforation with tamponade, and mortality within 30 days of procedure. Outcomes were compared between the two cohorts using the χ2 test. RESULTS A total of 4543 CIED implantation procedures were included with 1557 patients (34%) in the SDD cohort. SDD patients were comparatively younger, were more likely to be male, and had fewer comorbidities than DD patients. Among SDD patients, the mean time to post-operative chest X-ray was 2.6 h. SDD had lower rates of complications (1.3% vs 2.1%, p = 0.0487) and acute care utilization post-discharge (9.6% vs 14.0%, p < 0.0001). There was no difference in the 90-day infection rate between the cohorts. CONCLUSIONS An expedited 2 hour same-day discharge protocol is safe and effective with low rates of complications, infection, and post-operative acute care utilization.
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Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA.
| | - Kamala Swayampakala
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Aparna Rajwani
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elizabeth Davenport
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Fedor
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Sherry Saxonhouse
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Holshouser
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Neel Patel
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Joseph Thompson
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elijah Beaty
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Manish Jain
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Brian Powell
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
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Xu L, Su Y, Qin S, Ge J. Cardiac resynchronization therapy from an iliac approach in a patient without superior access: a case report. Eur Heart J Case Rep 2023; 7:ytad498. [PMID: 37869735 PMCID: PMC10587996 DOI: 10.1093/ehjcr/ytad498] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/15/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Background Cardiac resynchronization therapy (CRT) has been shown to benefit patients with heart failure and left bundle branch block (LBBB). However, CRT implantation is challenging when the superior venous access is not feasible. Case summary A 50-year-old man with a history of dilated cardiomyopathy and complete LBBB was referred to our hospital for CRT management. Angiography showed that the left and right brachiocephalic veins were occluded. Cardiac resynchronization therapy was finally implanted via the iliac vein. Follow-up echocardiography showed improved cardiac function, and the pacing system was functioning properly. Discussion The iliac vein access is feasible for CRT implantation with good stability, which can be a viable alternative to avoid unnecessary risk associated with thoracotomy and epicardial lead placement.
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Affiliation(s)
- Lei Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai 200032, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai 200032, China
| | - Shengmei Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai 200032, China
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Rathi C, Vyas A, Bachani N, Panicker G, Lokhandwala Y. Correlation of newer indices of dyssynchrony with clinical response in patients undergoing cardiac resynchronisation therapy. Indian Heart J 2020; 73:223-227. [PMID: 33865524 PMCID: PMC8065358 DOI: 10.1016/j.ihj.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 12/17/2020] [Indexed: 10/25/2022] Open
Abstract
The benefits of CRT in select subsets of systolic heart failure patients with LBBB are proven. We prospectively evaluated conventional and newer echocardiographic parameters of left ventricular dyssynchrony in 35 patients who underwent CRT and were followed up after 6 months. Of the 33 surviving patients, 21 were echocardiographic responders and 24 were clinical responders. The parameters in clinical responders and non-responders were compared. The anatomic M Mode parameters of delays improved, while the radial strain and the mitral valve velocity time integral (MVVTI) did not show any significant change after CRT.
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Affiliation(s)
- Chetan Rathi
- Holy Family Hospital and Research Centre, Mumbai, India
| | | | - Neeta Bachani
- Holy Family Hospital and Research Centre, Mumbai, India
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Abstract
Atrial fibrillation (AF) and heart failure (HF) are associated with high morbidity and mortality, which is particularly detrimental when patients develop rapid ventricular rates (RVR). Atrioventricular junction (AVJ) ablation with pacemaker implantation has been used as a method of achieving rate control in patients with incessant AF with RVR. Right ventricular only pacing is known to be harmful in the setting of HF. His bundle pacing (HBP) and biventricular (BiV) pacing both offer durable pacing solutions that offer more physiologic activation. This review describes the benefits and drawbacks of HBP and BiV pacing in HF patients after AVJ ablation.
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Affiliation(s)
- Zak Loring
- Division of Cardiology, Section of Electrophysiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Clinical Research Institute, 200 Morris St, Durham, NC 27701, USA.
| | - Albert Y Sun
- Division of Cardiology, Section of Electrophysiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Division of Cardiology, Section of Electrophysiology, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA
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Abstract
Implantation of cardiac resynchronization therapy devices represents one of the more challenging and time-consuming procedures for the clinical electrophysiologist. This article reviews several strategies used to improve efficiency, safety, and effectiveness of cardiac resynchronization therapy implantation. The cornerstone of our strategy to improve efficiency, safety, and quality of cardiac resynchronization therapy implantation is the use of a telescoping guide system with high-quality venography. Competency in subclavian venoplasty and snaring techniques are essential to maintain efficiency and effectiveness during difficult cases.
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Afzal A, Watson J, Choi JW, Schussler JM, Assar MD. Takotsubo cardiomyopathy in the setting of complete heart block. Proc (Bayl Univ Med Cent) 2018; 31:502-505. [PMID: 30948993 DOI: 10.1080/08998280.2018.1499314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022] Open
Abstract
Few cases of coincident takotsubo cardiomyopathy and complete heart block (CHB) have been reported. A 62-year-old woman presented with typical chest pain and was found to have CHB with a left ventricular ejection fraction of 35% and apical ballooning on ventriculogram. The patient was transvenously paced and a permanent biventricular pacemaker was placed when the CHB did not resolve. Repeat echocardiography 15 days after the event showed the ejection fraction to be 50%. This case highlights management strategies in this unique situation.
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Affiliation(s)
- Aasim Afzal
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas
| | - John Watson
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas
| | - James W Choi
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas.,Division of Cardiology, Texas A&M College of Medicine Health Science CenterDallasTexas
| | - Jeffrey M Schussler
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas.,Division of Cardiology, Texas A&M College of Medicine Health Science CenterDallasTexas
| | - Manish D Assar
- Division of Cardiology, Baylor University Medical Center, The Baylor Scott & White Heart Vascular HospitalDallasTexas.,Division of Cardiology, Texas A&M College of Medicine Health Science CenterDallasTexas
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Foerst JR, Kim D, May TP. Percutaneous electrosurgical technique for treatment of subclavian vein occlusion: Application of transcaval techniques. HeartRhythm Case Rep 2017; 3:551-554. [PMID: 29387548 PMCID: PMC5778100 DOI: 10.1016/j.hrcr.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jason R Foerst
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - David Kim
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Terrence P May
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
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Abstract
The decision to employ defibrillator therapy in patients with non-ischemic cardiomyopathy is driven by reduction in mortality. The strength of data supporting this therapy has led to its incorporation in medical guidelines and general practice across the world. Cardiac resynchronization therapy has also been proven to reduce heart failure hospitalization and improve quality of life. Although trends toward reduction in arrhythmic events have been observed, results in multicenter, randomized controlled trials have not been compelling for stand-alone use in most patients who currently meet criteria for defibrillator therapy.
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Affiliation(s)
- John Lacy Sturdivant
- Division of Cardiology, Medical University of South Carolina, 4065 Blackmoor Street, Mount Pleasant, Charleston, SC 29466, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, 25 Courtenay Drive ART 7031, MSC 592, Charleston, SC 29425-5920, USA.
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Finegold J, Bordachar P, Kyriacou A, Sohaib SMA, Kanagaratnam P, Ploux S, Lim B, Peters N, Davies W, Ritter P, Francis DP, Whinnett ZI. Atrioventricular delay optimization of cardiac resynchronisation therapy: comparison of non-invasive blood pressure with invasive haemodynamic measures. Int J Cardiol 2014; 180:221-2. [PMID: 25463371 DOI: 10.1016/j.ijcard.2014.11.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Received: 10/18/2014] [Revised: 11/14/2014] [Accepted: 11/22/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Judith Finegold
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | | | - Andreas Kyriacou
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | - S M Afzal Sohaib
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | - Prapa Kanagaratnam
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | | | - Boon Lim
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | - Nicholas Peters
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | - Wyn Davies
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
| | | | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK.
| | - Zachary I Whinnett
- International Centre for Circulatory Health, National Heart and Lung Institute, London, UK
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