Emerging Technologies in Cardiac Pacing From Leadless Pacers to Stem Cells

Modern pacemakers can sense and pace multiple chambers of the heart. These pacemakers have different modes and features to optimize atrioventricular synchrony and promote intrinsic conduction. Despite recent advancements, current pacemakers have several drawbacks that limit their feasibility. In this review article, we discuss several of these limitations and detail several emerging technologies in cardiac pacing aimed to solve some of these limitations. We present several technological advancements in cardiac pacing, including the use of leadless pacemakers, physiologic pacing, battery improvements, and bioartificial pacemakers. More research still needs to be done in testing the safety and efficacy of these new developments.

Is Exercise Helpful or Harmful in Dealing With Specific Arrhythmia

Exercise is universally known to benefit health by lowering risk for cardiovascular disease and mortality. However, in patients with pre-existing cardiac conditions, including channelopathies, cardiomyopathies and coronary artery disease, exercise can cause sudden cardiac death (SCD). In this review, we explore exercise related risks and current recommendations for specific conditions. The risk of myocardial infarction (MI) during strenuous exercise in asymptomatic individuals with coronary artery disease is decreased with habitual exercise, especially if they have a normal ejection fraction and no ischemia. Furthermore, cardiac rehabilitation has been shown to be beneficial in heart failure. On the other hand, surgery is recommended for certain anomalous coronaries prior to engaging in vigorous activity. In addition, both exercise-induced disease progression and SCD in arrhythmogenic cardiomyopathy restrict ability to engage in competitive sports, as is the case in hypertrophic cardiomyopathy. Other diseases, like myocarditis only cause temporary risk for SCD. Previously considered benign, common conditions like early repolarization do increase SCD risk. Finally, certain gear including thicker chest protectors for athletes engaging in sports with hard, small spherical objects decrease risk of commotio cordis. While significant advances have been achieved in diagnosing and treating previously unrecognized conditions that predispose to sudden cardiac death, more research is needed to further tailor recommendations to allow beneficial exercise in those with rarer conditions that are under-represented in large systemic studies.

Effects of Artificial Intelligence Clinical Decision Support Tools on Complications Following Percutaneous Coronary Intervention

Background

Artificial intelligence (AI) models have been created that incorporate unique patient characteristics to risk stratify patients undergoing cardiac catheterization with percutaneous coronary intervention (PCI). The most frequent complications following PCI are contrast-induced acute kidney injury (CI-AKI) and postprocedural bleeding, resulting in increased adverse outcomes, length of stay (LOS), and health care costs. Our study investigates the impact of AI clinical decision support tools on these events.

Methods

A retrospective review of patients undergoing PCI at our institution from April 2023 to March 2024 was performed. All patients had an ePRISM (Terumo Health Outcomes AI clinical decision support tool) generated risk assessment and maximum contrast volume recommendation reported during procedure time-out. Statistical analysis was performed to determine the incidence of post-PCI CI-AKI, bleeding events, and LOS.

Results

A total of 642 patients were analyzed. The incidence of CI-AKI significantly declined from a baseline of 10% to an average of 2.18% (P < .0001). Of the remaining CI-AKI, 92.9% occurred in hospitalized patients. The incidence of bleeding complications declined from a baseline incidence of 2.15 per month to an average of 1.54 per month. Our institution's average LOS declined from a baseline of 3.44 to 1.79 days.

Conclusions

AI clinical decision support tools can be effectively incorporated into clinical practice. ePRISM successfully risk-stratified patients undergoing PCI for CI-AKI and bleeding events and gave meaningful recommendations which resulted in a significant reduction in adverse events and LOS.