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Pubblicazioni recenti - cardiac resynchronization
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Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices.
Am J Cardiovasc Drugs2020 Oct;():. doi: 10.1007/s40256-020-00448-4.
Cheng Sijing, Zhang Nixiao, Hua Wei,
Abstract
For heart failure patients with cardiac implantable electronic devices (CIEDs), especially those who remain symptomatic after implantation, the best management strategy is still unclear. Although there are several concerns regarding the clinical utilization of sacubitril/valsartan, it has improved the prognosis of patients with heart failure compared with the use of renin-angiotensin system inhibitors in recent years. Recent real-world observational studies and post hoc analyses demonstrated that sacubitril/valsartan might have effects in patients with CIEDs. Given its potential underlying mechanisms, sacubitril/valsartan could improve outcomes of mortality and sudden cardiac death incidence, as well as clinical and echocardiographic evaluations. The possible antiarrhythmic effect of sacubitril/valsartan is still debated. Moreover, given that hypotension is the critical limitation of uptitration, the rise in systolic blood pressure attributed to cardiac resynchronization therapy might support the use of sacubitril/valsartan, with improved tolerance. The clinical utility of sacubitril/valsartan in heart failure patients with CIEDs requires further investigation to determine the actual effects, optimal target populations, and underlying mechanisms.
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Cost-Effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure in Thailand.
Clinicoecon Outcomes Res2020 ;12():579-588. doi: 10.2147/CEOR.S268553.
Permsuwan Unchalee, Phrommintikul Arintaya, Silavanich Voratima,
Abstract
Background:
Cardiac resynchronization therapy (CRT) improves symptoms and survival in patients with heart failure (HF). However, the CRT devices are costly and can impose a significant burden to the relatively constrained health budgets of middle-income countries such as Thailand. The aim of this study was to analyze the cost-effectiveness of CRT in combination with optimal medical therapy (OMT) relative to patients with OMT alone.
Methods:
A two-component model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from a healthcare perspective. Clinical inputs were mostly obtained from meta-analysis of landmark trials. All cost-related data, risk of non-cardiovascular death and readmission rate were based on Thai HF data. Costs and QALYs were discounted at 3%. Findings were reported as an incremental cost-effectiveness ratio (ICER). A variety of sensitivity analyses were also performed.
Results:
CRT plus OMT costs more than OMT (123,279 vs 11,165 THB or 3,972.90 vs 359.81 USD), and is more effective (3.57 QALYs vs 2.49 QALYs), yielding an ICER of 104,325 THB per QALY (3,362.07 USD per QALY). CRT was cost-effective at the Thai willingness to pay threshold of 160,000 THB per QALY (5,156.30 USD per QALY). The results were sensitive to cost of CRT maintenance.
Conclusion:
The use of CRT was associated with a cost-effectiveness ratio below generally accepted benchmarks for therapeutic interventions of 160,000 THB per QALY (5,156.30 USD per QALY). This suggests that the clinical benefits of CRT can be achieved at a reasonable cost in Thai HF patients.
© 2020 Permsuwan et al.
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Associations of the Prognostic Nutritional Index with the Cardiac Function and Survival after Cardiac Resynchronization Therapy.
Intern Med2020 Oct;():. doi: 10.2169/internalmedicine.5961-20.
Yamada Shinya, Yoshihisa Akiomi, Hijioka Naoko, Amami Kazuaki, Kaneshiro Takashi, Ishida Takafumi, Takeishi Yasuchika,
Abstract
Objective The relationship between changes in the nutritional status after cardiac resynchronization therapy (CRT) and the prognosis has not been fully elucidated. We aimed to evaluate the changes in the nutritional status as assessed by the prognostic nutritional index (PNI) and their associations with the improvement in the cardiac function and subsequent clinical outcomes. Methods The study population consisted of 119 patients with a CRT-device. They were divided into 2 groups, based on whether their PNI had increased at 6 months after CRT-device implantation (positive ?PNI group, n=73) or not (negative ?PNI group, n=46). The left ventricular (LV) end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were measured before and six months after CRT-device implantation. We compared the changes in the cardiac function and prevalence of adverse events (re-hospitalization due to worsening heart failure or all cause death) between the two groups. Results In the positive ?PNI group, the LVEDV (186±93 mL vs. 149±71 mL, p<0.05) and LVESV (134±75 mL vs. 98±62 mL, p<0.05) were significantly decreased 6 months after CRT-device implantation. In addition, the LVEF (31±11% vs. 37±12%, p<0.05) was significantly increased after CRT-device implantation. In the negative ?PNI group, no significant changes were observed in any echocardiographic parameters. During a median follow-up period of 914 days, there were 67 (56.3%) adverse events. In the Kaplan-Meier analysis, the positive ?PNI group was associated with a lower risk of adverse events than the negative ?PNI group (50.6% vs. 65.2%, log-rank p=0.042). Conclusion Our results suggest that improvement in the cardiac function after CRT-device implantation is associated with increases in the PNI, resulting in favorable outcomes.
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In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample.
J Investig Med2020 Oct;():. doi: jim-2020-001501.
Jamal Shakeel M, Kichloo Asim, Albosta Michael, Bailey Beth, Singh Jagmeet, Wani Farah, Shah Zaib Muhammad, Ahmad Muhammad, Khan Muhammad Dilawar, Soni Ronak, Aljadah Michael, Khan Hafiz Waqas, Khan Mahin, Khan Muhammad Z,
Abstract
Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.
© American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Epicardial lead placement for cardiac resynchronization therapy in dilated cardiomyopathy patient: Fine tuning anaesthetic challenges.
Ann Card Anaesth;23(4):537-538. doi: 10.4103/aca.ACA_7_19.
Damodaran Srinath, Gandhi Komal, Mandal Banashree, Mishra Anand Kumar,
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[CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome].
Praxis (Bern 1994)2020 ;109(14):1117-1118. doi: 10.1024/1661-8157/a003544.
Oechslin Luca, Hofer Daniel, Hermann Matthias,
Abstract
CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.
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Regional protein expression changes within the left ventricle in a mouse model of dyssynchronous and resynchronized heart failure.
ESC Heart Fail2020 Oct;():. doi: 10.1002/ehf2.13038.
Nordin Hugo, Nakagawa Ryo, Wallin Marita, Pernow John, Kass David A, Ståhlberg Marcus,
Abstract
AIMS:
The biological mechanisms conveying the salutary effects of cardiac resynchronization therapy in heart failure remain elusive. We have recently developed a mouse model of heart failure with dyssynchrony/resynchronization. The aim of this study was to characterize regional left ventricular heterogeneity in protein expression comparing early (septum) and late (lateral) activated left ventricular wall segments in synchronous (SHF), dyssynchronous (DHF), and resynchronized heart failure (RHF).
METHODS AND RESULTS:
Mice subjected to ischaemia/reperfusion were divided into three groups: sinus rhythm for 4 weeks (SHF), right ventricular pacing for 4 weeks (DHF), and right ventricular pacing for 2 weeks and 2 weeks of sinus rhythm (RHF). Relative concentrations of 92 proteins from septal and lateral left ventricular wall segments (n = 10 per group) were compared within each group. We also analysed the effect of DHF vs. SHF and RHF vs. DHF on protein expression pattern comparing the same left ventricular segments between the groups. Proteins with significantly differential expression between left ventricular segments were analysed for protein-protein correlations, protein-protein interactions, and biological and signalling pathways. Eight proteins were significantly down-regulated in the late activated (compared with early activated) lateral wall uniquely in RHF (P < 0.05 adjusted for a 5% false discovery rate): Erbb4, Ntf3, Pdgfb, Tnf, Notch3, Qdpr, Tpp1, and Itgb6. Protein correlation matrix showed that six of these were strongly and positively correlated and five had known protein-protein interactions. Biological pathways mainly down-regulated in late activated myocardium in RHF were MAPK signalling and hypertrophic cardiomyopathy. There were no significantly differentially expressed proteins comparing the same left ventricular segments between the DHF and SHF (range of P-values: 0.05-1.00) and RHF and DHF (range of P-values: 0.32-1.00).
CONCLUSIONS:
In a mouse model of heart failure with dyssynchrony and resynchronization, we observed down-regulation of several proteins in the late activated lateral wall, compared with the septum, in resynchronized mice. These proteins display significant protein-protein correlation and share biological signalling pathways, including MAPK activation and hypertrophy signalling.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Preventive infection control in cardiac device implantation.
Herzschrittmacherther Elektrophysiol2020 Oct;():. doi: 10.1007/s00399-020-00727-2.
Khalifa Maha Mohamed Mohamed, Kolta Michel Lotfy, Tawfik Mazen, Khaled Said, Fakhry Emad Effat,
Abstract
BACKGROUND:
Cardiac implantable electronic devices have been increasingly used in recent years; as a result, there has been a rise in device-related complications. Pacemaker-associated infection is challenging to manage, including system removal, antimicrobial therapy and reimplantation at another site. The aim of this study was to evaluate adherence to the steps in an infection control protocol in cardiac device implantation.
RESULTS:
A total of 100 patients referred for cardiac device implantation were enrolled in the study. They were evaluated with regard to the application of infection control measures during device implantation and followed-up for 6 months to detect clinical signs of device-related infection (DRI). A significant correlation was found between the development of postoperative DRI and the presence or absence of the following factors: increasing patient age (p?=?0.010), diabetes mellitus (p?=?0.024), number of operators ?4 (p?=?0.001), implantation of a biventricular system (p?=?0.025), duration of sterilization (p?=?0.001), wearing double gloves (p?
CONCLUSIONS:
The study identified the following risk factors for DRI: age, diabetes mellitus and cardiac resynchronization therapy system implantation (p?=?0.025). Antiseptic measures such as double-glove technique and duration of skin disinfection prior to the procedure, as well as environmental factors, also influenced device infection, as did the number of operators/staff and pocket hematoma.
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Deep septal, distal His bundle pacing for cardiac resynchronization therapy.
HeartRhythm Case Rep -
Utility of 3-D printing for cardiac resynchronization device implantation in congenital heart disease.
HeartRhythm Case Rep2020 Oct;6(10):754-756. doi: 10.1016/j.hrcr.2020.07.011.
Kanawati Juliana, Kanawati Andrew J, Rowe Matthew K, Khan Habib, Chan William K, Yee Raymond,
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Real-world safety of magnetic resonance imaging after His bundle pacemaker implantation.
HeartRhythm Case Rep2020 Oct;6(10):697-701. doi: 10.1016/j.hrcr.2020.06.019.
Carter Spencer V, Jameria Zenith, Karagodin Ilya, Tung Roderick, Upadhyay Gaurav A,
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Integration of activation maps of epicardial veins in computational cardiac electrophysiology.
Comput Biol Med2020 Oct;127():104047. doi: S0010-4825(20)30378-4.
Stella Simone, Vergara Christian, Maines Massimiliano, Catanzariti Domenico, Africa Pasquale Claudio, Demattè Cristina, Centonze Maurizio, Nobile Fabio, Del Greco Maurizio, Quarteroni Alfio,
Abstract
In this work we address the issue of validating the monodomain equation used in combination with the Bueno-Orovio ionic model for the prediction of the activation times in cardiac electro-physiology of the left ventricle. To this aim, we consider four patients who suffered from Left Bundle Branch Block (LBBB). We use activation maps performed at the septum as input data for the model and maps at the epicardial veins for the validation. In particular, a first set (half) of the latter are used to estimate the conductivities of the patient and a second set (the remaining half) to compute the errors of the numerical simulations. We find an excellent agreement between measures and numerical results. Our validated computational tool could be used to accurately predict activation times at the epicardial veins with a short mapping, i.e. by using only a part (the most proximal) of the standard acquisition points, thus reducing the invasive procedure and exposure to radiation.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Left bundle branch block is associated with a similar Dyssynchronous phenotype in heart failure patients with Normal and reduced ejection fractions.
Am Heart J2020 Oct;():. doi: S0002-8703(20)30338-0.
Friedman Daniel J, Emerek Kasper, Kisslo Joseph, Søgaard Peter, Atwater Brett,
Abstract
BACKGROUND:
Few therapies improve outcomes in patients with heart failure with preserved ejection fraction (HFpEF). If left bundle branch block (LBBB) is associated with left ventricular dyssynchrony and impaired cardiac performance in HFpEF, cardiac resynchronization therapy(CRT) could be a promising treatment.
METHODS:
We performed a cross sectional analysis of selected patients with HFpEF (ejection fraction ?50%) with and without LBBB (normal conduction, NC) and patients with HFrEF and LBBB who were suitable CRT candidates to describe and contextualize the mechanical phenotype of LBBB in HFpEF. Systolic and diastolic isovolumic times, ejection time(ET), and diastolic filling time(DFT) were measured on spectral tissue Doppler echocardiographic images and indexed to the heart rate. Dyssynchrony pattern was assessed using speckle tracked longitudinal strain patterns. Comparisons were performed using ANOVA and ? test with post-hoc pairwise comparisons as indicated.
RESULTS:
Eighty-two HFpEF (50 with NC, 32 with LBBB) and 149 HFrEF (all with LBBB) patients met criteria. Overall, 84.4% with HFpEF/LBBB and 91.3% with HFrEF/LBBB had demonstrable mechanical dyssynchrony, compared to 0% with HFpEF/NC. Compared to HFpEF/NC, HFpEF/LBBB had significantly prolonged isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and total isovolumetric time and significantly shorter ET (all indexed). LBBB/HFrEF patients, compared to LBBB/HFpEF patients, had increased ICT and IRT, with decreased DFT but similar ET.
CONCLUSIONS:
Patients with HFpEF and LBBB frequently have a LBBB dyssynchrony phenotype, prolonged ICT and IRT, and reduced ET compared to HFpEF patients with NC. The electromechanical dyssynchrony and disordered cardiac timing of HFpEF with LBBB is similar to HFrEF with LBBB.
Published by Elsevier Inc.
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Cardiac resynchronization therapy in heart failure patients: tough road but clear future.
Heart Fail Rev2020 Oct;():. doi: 10.1007/s10741-020-10040-2.
Wang Ziyu, Zhang Junmeng, Wu Yongquan,
Abstract
Cardiac resynchronization therapy (CRT) based on biventricular pacing (BVP) is an invaluable intervention currently used in heart failure (HF) patients. The therapy involves electromechanical dyssynchrony, which can not only improve heart function and quality of life but also reduce hospitalization and mortality rates. However, approximately 30% to 40% of patients remain unresponsive to conventional BVP in clinical practice. In the recent years, extensive research has been employed to find a more physiological approach to cardiac resynchronization. The His-Purkinje system pacing (HPSP) including His bundle pacing (HBP) and left bundle branch area pacing (LBBaP) may potentially be the future of CRT. These technologies present various advantages including offering an almost real physiological pacing, less complicated procedures, and economic feasibility. Additionally, other methods, such as isolated left-ventricular pacing and multipoint pacing, may in the future be important but non-mainstream alternatives to CRT because currently, there is no strong evidence to support their effectiveness. This article reviews the current situation and latest progress in CRT, explores the existing technology, and highlights future prospects in the development of CRT.
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Is Image Guidance for Left Ventricular Lead Targeting Overkill?
JACC Clin Electrophysiol2020 Oct;6(10):1310-1312. doi: S2405-500X(20)30570-3.
Friedman Daniel J, Singh Jagmeet P,
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Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging: A Randomized Controlled Study.
JACC Clin Electrophysiol2020 Oct;6(10):1300-1309. doi: S2405-500X(20)30382-0.
Borgquist Rasmus, Carlsson Marcus, Markstad Hanna, Werther-Evaldsson Anna, Ostenfeld Ellen, Roijer Anders, Bakos Zoltan,
Abstract
OBJECTIVES:
This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodality imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT).
BACKGROUND:
LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated.
METHODS:
This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmural scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n = 70). The primary endpoint was reduction of LV end-systolic volume by ?15% at 6 months post-implantation.
RESULTS:
Patients were followed for 47 ± 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved ?1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07).
CONCLUSIONS:
Radial strain-guided LV lead placement, in combination with multimodality imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment [CRT Clinic]; NCT01426321).
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Lateral left ventricular lead position is superior to posterior position in long-term outcome of patients who underwent cardiac resynchronization therapy.
ESC Heart Fail2020 Oct;():. doi: 10.1002/ehf2.13066.
Behon Anett, Schwertner Walter Richard, Merkel Eperke Dóra, Kovács Attila, Lakatos Bálint Károly, Zima Endre, Gellér László, Kutyifa Valentina, Kosztin Annamária, Merkely Béla,
Abstract
AIMS:
Preferring side branch of coronary sinus during cardiac resynchronization therapy (CRT) implantation has been empirical due to the limited data on the association of left ventricular (LV) lead position and long-term clinical outcome. We evaluated the long-term all-cause mortality by LV lead non-apical positions and further characterized them by interlead electrical delay (IED).
METHODS AND RESULTS:
In our retrospective database, 2087 patients who underwent CRT implantation were registered between 2000 and 2018. Those with non-apical LV lead locations were classified into anterior (n = 108), posterior (n = 643), and lateral (n = 1336) groups. All-cause mortality was assessed by Kaplan-Meier and Cox analyses. Echocardiographic response was measured 6 months after CRT implantation. During the median follow-up time of 3.7 years, 1150 (55.1%) patients died-710 (53.1%) with lateral, 78 (72.2%) with anterior, and 362 (56.3%) with posterior positions. When we investigated the risk of all-cause mortality, there was a significantly lower rate of death in patients with lateral LV lead location when compared with those with an anterior (P < 0.01) or posterior (P < 0.01) position. Multivariate analysis after adjustment for relevant clinical covariates such as age, sex, ischaemic aetiology, left bundle branch block morphology, atrial fibrillation, and device type revealed consistent results that lateral position is associated with a significant risk reduction of all-cause mortality when compared with anterior [hazard ratio 0.69; 95% confidence interval (CI) 0.55-0.87; P < 0.01] or posterior (hazard ratio 0.84; 95% CI 0.74-0.96; P < 0.01) position. When echocardiographic response was evaluated within the lateral group, patients with an IED longer than 110 ms (area under the receiver operating characteristic curve, 0.63; 95% CI 0.53-0.73; P = 0.012) showed 2.1 times higher odds of improvement in echocardiographic response 6 months after the implantation.
CONCLUSIONS:
In this study, we proved in a real-world patient population that after CRT implantation, lateral LV lead location was associated with long-term mortality benefit and is superior to both anterior and posterior positions. Moreover, patients with this position showed the greatest echocardiographic response over 110 ms IED.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices.
Eur Heart J Case Rep2020 Oct;4(FI1):1-6. doi: 10.1093/ehjcr/ytaa249.
Ahmed Fozia Zahir, Crosbie Carol, Kahn Matthew, Motwani Manish,
Abstract
Background:
Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic.
Case summary:
An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The 'Triage Heart Failure Risk Score' (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any 'high' Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient's home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner.
Discussion:
The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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VVI Pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers.
Pacing Clin Electrophysiol2020 Oct;():. doi: 10.1111/pace.14100.
Loring Zak, North Rebecca, Hellkamp Anne S, Atwater Brett D, Frazier-Mills Camille G, Jackson Kevin P, Pokorney Sean D, Lamas Gervasio A, Piccini Jonathan P,
Abstract
BACKGROUND:
Leadless pacemakers (LPs) provide ventricular pacing without the risks associated with transvenous leads and device pockets. LPs are appealing for patients who need pacing, but do not need defibrillator or cardiac resynchronization therapy. Most implanted LPs provide right ventricular pacing without atrioventricular synchrony (VVIR mode). The Mode Selection Trial in Sinus Node Dysfunction Trial (MOST) showed similar outcomes in patients randomized to dual chamber (DDDR) vs ventricular pacing (VVIR). We compared outcomes by pacing mode in LP-eligible patients from MOST.
METHODS:
Patients enrolled in the MOST study with an LVEF >35%, QRSd <120ms and no history of ventricular arrhythmias or prior implantable cardioverter defibrillators were included (LP-eligible population). Cox proportional hazards models were used to test the association between pacing mode and death, stroke or heart failure hospitalization and atrial fibrillation (AF).
RESULTS:
Of the 2,010 patients enrolled in MOST, 1,284 patients (64%) met inclusion criteria. Baseline characteristics were well balanced across included patients randomized to DDDR (N = 630) and VVIR (N = 654). Over four years of follow-up, there was no association between pacing mode and death, stroke or heart failure hospitalization (VVIR HR 1.28 [0.92-1.75]). VVIR pacing was associated with higher risk of AF (HR 1.32 [1.08-1.61], p = 0.007), particularly in patients with no history of AF (HR 2.38 [1.52-3.85], p<0.001).
CONCLUSION:
In patients without reduced LVEF or prolonged QRS duration who would be eligible for LP, DDDR and VVIR pacing demonstrated similar rates of death, stroke or heart failure hospitalization; however, VVIR pacing significantly increased the risk of AF development. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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A hybrid endocardial-epicardial biventricular implantable cardioverter-defibrillator to circumvent the tricuspid valve.
Pacing Clin Electrophysiol2020 Oct;():. doi: 10.1111/pace.14099.
Ip James E, Krishnan Udhay, Girardi Leonard N, Lerman Bruce B,
Abstract
The development of pacing and defibrillator systems that do not involve hardware traversing the tricuspid annulus can be desirable in order to minimize lead-related complications such as tricuspid regurgitation. Occasionally, primary tricuspid valve pathology (ie, infectious endocarditis, nonbacterial thrombotic endocarditis, and carcinoid disease) or congenital heart disease prohibits use of transvenous leads and alternative strategies are required to provide pacing or defibrillation. We describe such a case in which a biventricular implantable cardioverter defibrillator was implanted using a hybrid system involving endocardial and epicardial components.
© 2020 Wiley Periodicals LLC.
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