1
|
Wileczek A, Reichert A, Kluk M, Sledz S, Sledz A, Kosior J, Polewczyk A, Kutarski A, Jagielski D, Buchta-Nitecka A, Karbarz D, Stec S. Non-invasive and invasive autonomic tests to facilitate cardioneuroablation and complex indications for transcutaneous lead extraction and discontinuation of permanent pacing. Europace 2021. [DOI: 10.1093/europace/euab116.490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Rare-A-Care registry
Background
Extracardiac vagal nerve stimulation (ECANS) and cardioneuroablation (CNA) are promising methods to cure vagally mediated bradycardia and validate indications for permanent pacing for sinus node dysfunction (SND), atrioventricular blocks (AVB), tachycardia-bradycardia syndrome (TBS) and cardio-inhibitory or mixed reflex syncope (VVS). There are limited information on clinical utility of those procedures in validation of indication for continuation of permanent pacing (PM) and transcutaneous lead extraction (TLE).
Methods
Data were collected from prospective multicentre registry of CNA facilitated by interdisciplinary consultations, state-of-art autonomic tests, atropine/propranolol tests, electrophysiologic study as well as ECANS. Share-decision making were used by EP-HEART-TEAM to developed patient-oriented therapy.
Results
Between June 2018-Jan 2021 the first 102 consecutive patients underwent interdisciplinary approach before invasive EPS and/or invasive ECANS, to consider biatrial, binodal CNA, if possible to cure functional bradycardia. Eleven (10%) patients had implanted permanent PM"s due to SND/AVB/TBS/CI-VVS and were considered for TLE. In 2 out of 11 cases CNA was not performed due to: 1) structural advanced 2nd and 3rd degree AVB with indication for TLE and permanent HBP (no.1), 2) incidental severely symptomatic persistent 3rd degree AVB more than 15 year ago without any further bradycardia episodes (only TLE, no.2). In further 9 of 11 cases with PM CNA was performed, however TLE was not attempted in 2 patients [(SND + PVC ablation + indication for beta-blocker therapy due to IHD in older male. TLE had not yet been attempted to confirm long-term success therapy by patient and/or physician (no.3); two periprocedural successful CNA resulted in disappearance of CI reflex however despite pacing syncopal events persist due to mixed etiology (no.4)]. In further 7/11 cases TLE-s were performed. Three cases had TLE prior to CNA [VVS-CI + advanced functional AVB - prior 3 pacemaker reimplantations and further "rescue" CNA, (no.5); CI-VVS + pacemaker infection (no.6); TLE of PM + TBS no.7]. Finally, in 4 cases TLE was recommended after CNA [CI-VVS (no.8, no.9 and no.10); mixed etiology: TBS + VVS-CI + intermittent, recurrent pericardial efffusion due to lead perforation, PM syndrome, (no. 11)].
Conclusions
Interdisciplinary and comprehensive autonomic approach with ECANS and CNA enable EP-HEART-TEAM to offer patient-oriented therapy with a complex clinical scenarios before final decision about TLE and discontinuation of permanent pacing therapy.
Collapse
Affiliation(s)
- A Wileczek
- Subcarpathian Centre for Cardiovascular Interventions, Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Sanok, Poland
| | - A Reichert
- County Specialistic Hospital in Stalowa Wola, Department of Cardiology, Stalowa Wola, Poland
| | - M Kluk
- Swietokrzyskie Cardiology Center, Department of Interventional Cardiology, Kielce, Poland
| | - S Sledz
- El-Medica, EP-NETWORK, Skarzysko-Kamienna, Poland
| | - A Sledz
- El-Medica, EP-NETWORK, Skarzysko-Kamienna, Poland
| | - J Kosior
- Mazovian Specialist Hospital, Radom, Poland
| | - A Polewczyk
- Swietokrzyskie Cardiology Center, Department of Cardiac Surgery, Kielce, Poland
| | - A Kutarski
- Regional Hospital Pope John Paul II, Zamosc, Poland
| | | | | | - D Karbarz
- El-Medica, EP-NETWORK, Skarzysko-Kamienna, Poland
| | - S Stec
- Subcarpathian Centre for Cardiovascular Interventions, Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Sanok, Poland
| |
Collapse
|
2
|
Murray HW, Squires KE, Weiss W, Sledz S, Sacks HS, Hassett J, Cross A, Anderson RE, Dunkle LM. Stavudine in patients with AIDS and AIDS-related complex: AIDS clinical trials group 089. J Infect Dis 1995; 171 Suppl 2:S123-30. [PMID: 7861017 DOI: 10.1093/infdis/171.supplement_2.s123] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In a phase I trial of stavudine in AIDS or AIDS-related complex (ARC), antiviral effects and safety were assessed in 41 patients treated with dosages of 0.5-12.0 mg/kg/day. Among evaluable patients, 10% increases in CD4 lymphocyte counts were sustained in 24 (60%) of 40 during treatment; an NAUC response (normalized area under the CD4 cell count-versus-time curve > 1.0) was observed in 31 (91%) of 34 at 10 weeks and in 20 (80%) of 25 at 24 weeks; 15 (83%) of 18 had decreases in p24 antigenemia; and 24 (60%) of 40 gained > or = 2.5 kg body weight. Median CD4 lymphocyte levels remained above baseline for 6 months in patients receiving > 0.5 mg/kg/day. Median serum p24 antigen levels remained below baseline for > or = 1 year in patients with p24 antigen responses. The principal toxicity was peripheral neuropathy, which generally resolved after drug discontinuation but limited the dosage to < or = 2.0 mg/kg/day. Additional trials assessing the effect of stavudine on overall morbidity and mortality are ongoing.
Collapse
Affiliation(s)
- H W Murray
- Division of Infectious Diseases, Cornell University Medical College, New York, New York
| | | | | | | | | | | | | | | | | |
Collapse
|