Pub Date : 2024-03-01DOI: 10.1016/j.hroo.2024.01.004
John L. Mignone MD, PhD , Kevin M. Alexander MD , Michael Dobbles MS , Kyle Eberst MBA , Gregg C. Fonarow MD , Kenneth A. Ellenbogen MD
Background
Limited real-world evidence exists for outcomes with contemporary guideline-directed medical therapy (GDMT) or GDMT with implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) therapy for patients with heart failure with reduced ejection fraction (HFrEF) and left ventricular ejection fraction (LVEF) ≤35%.
Objective
The present study aimed to assess survival associated with GDMT or GDMT with ICD/CRT-D therapy.
Methods
This retrospective observational study included real-world de-identified data from January 1, 2016, to December 19, 2023, from 24 U.S. institutions per participating institutional agreements (egnite Database; egnite, Inc.). Patients with a diagnosis of HFrEF and an echocardiographic study documenting LVEF ≤35% were included for analysis.
Results
Of 43,591 patients with eligible index event of LVEF ≤35%, prescription history through ≥1 year preindex, and no ICD/CRT-D therapy preindex, mean ± standard deviation age at index was 71.2 ± 13.2 years; 14,805 (34.0%) patients were female. At 24 months, an estimated 99.1% (95% confidence interval [CI] 99.0%–99.2%), 89.9% (95% CI 89.7%–90.1%), 54.8% (95% CI 54.4%–55.2%), and 17.2% (95% CI 16.9%–17.5%), had ≥1, 2, 3, or all 4 GDMT classes prescribed, respectively; an estimated 15.7% (95% CI 15.3%–16.1%) had device placement. Of those without a device, by 24 months, an estimated 45.1% (95% CI 44.4%–45.7%) had a documented LVEF >35%. Counts of GDMT classes prescribed as well as ICD/CRT-D device therapy were associated with lower mortality risk in this population, even after adjustment for patient age, sex, and comorbidities.
Conclusion
Both GDMT classes prescribed and device therapy were independently associated with lower mortality risk, even in the presence of more GDMT options for this more contemporary population.
{"title":"Outcomes with guideline-directed medical therapy and cardiac implantable electronic device therapies for patients with heart failure with reduced ejection fraction","authors":"John L. Mignone MD, PhD , Kevin M. Alexander MD , Michael Dobbles MS , Kyle Eberst MBA , Gregg C. Fonarow MD , Kenneth A. Ellenbogen MD","doi":"10.1016/j.hroo.2024.01.004","DOIUrl":"10.1016/j.hroo.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Limited real-world evidence exists for outcomes with contemporary guideline-directed medical therapy (GDMT) or GDMT with implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) therapy for patients with heart failure with reduced ejection fraction (HFrEF) and left ventricular ejection fraction (LVEF) ≤35%.</p></div><div><h3>Objective</h3><p>The present study aimed to assess survival associated with GDMT or GDMT with ICD/CRT-D therapy.</p></div><div><h3>Methods</h3><p>This retrospective observational study included real-world de-identified data from January 1, 2016, to December 19, 2023, from 24 U.S. institutions per participating institutional agreements (egnite Database; egnite, Inc.). Patients with a diagnosis of HFrEF and an echocardiographic study documenting LVEF ≤35% were included for analysis.</p></div><div><h3>Results</h3><p>Of 43,591 patients with eligible index event of LVEF ≤35%, prescription history through ≥1 year preindex, and no ICD/CRT-D therapy preindex, mean ± standard deviation age at index was 71.2 ± 13.2 years; 14,805 (34.0%) patients were female. At 24 months, an estimated 99.1% (95% confidence interval [CI] 99.0%–99.2%), 89.9% (95% CI 89.7%–90.1%), 54.8% (95% CI 54.4%–55.2%), and 17.2% (95% CI 16.9%–17.5%), had ≥1, 2, 3, or all 4 GDMT classes prescribed, respectively; an estimated 15.7% (95% CI 15.3%–16.1%) had device placement. Of those without a device, by 24 months, an estimated 45.1% (95% CI 44.4%–45.7%) had a documented LVEF >35%. Counts of GDMT classes prescribed as well as ICD/CRT-D device therapy were associated with lower mortality risk in this population, even after adjustment for patient age, sex, and comorbidities.</p></div><div><h3>Conclusion</h3><p>Both GDMT classes prescribed and device therapy were independently associated with lower mortality risk, even in the presence of more GDMT options for this more contemporary population.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 3","pages":"Pages 168-173"},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000059/pdfft?md5=db260c30524c4864727888956467bdee&pid=1-s2.0-S2666501824000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2023.11.006
Bernard Belhassen MD
{"title":"Contributions of Israel to the field of clinical cardiac electrophysiology and implantable devices","authors":"Bernard Belhassen MD","doi":"10.1016/j.hroo.2023.11.006","DOIUrl":"https://doi.org/10.1016/j.hroo.2023.11.006","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 67-84"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501823002970/pdfft?md5=786211079a6554478aa3a9740cd10d3b&pid=1-s2.0-S2666501823002970-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The complexity of leadless pacemaker (LP) implantation varies widely. However, the predictive factors determining this difficulty are poorly understood.
Objective
The purpose of this study was to evaluate the factors influencing LP implantation difficulty, specifically procedural time during right atrial (RA) and right ventricular (RV) manipulation, based on patient background, cardiac function, and anatomic characteristics.
Methods
Analysis included LP implantation cases between 2017 and 2023, excluding the initial 3 implants performed by each operator. The relevance of patient background, cardiac function, and anatomic features on procedural and fluoroscopy times was evaluated.
Results
Fifty-four patients (mean age 82.2 ± 10.0 years; 57.4% male) were included in the study. Median procedural and fluoroscopy time was 45.8 minutes and 16.0 minutes, respectively, with an average of 2.0 ± 1.4 device deployments. Univariate analysis showed associations between procedural time and older age, RA and RV diameter, and severity of tricuspid regurgitation (TR). After adjustment for physician and potential contributing factors, RV dilation (midventricular diameter ≥35 mm) and severe TR were identified as independent predictors of prolonged procedural time. Medical history exhibited no association with procedural time. Consistent results were observed in analyses using fluoroscopy time as the outcome.
Conclusion
RV dilation and severe TR were associated with prolonged procedural time for LP implantation. Anatomic features obtained from preprocedural echocardiography could provide valuable insights into both the safety and efficiency of LP implantation, thereby enhancing tailored treatment strategies for patients undergoing pacemaker implantation.
{"title":"Assessment of patient characteristics influencing the complexity of leadless pacemaker implantation","authors":"Hiroshi Miyama MD, PhD, Yukihiro Himeno MD, Shuhei Yano MD, Shuhei Yamashita MD, Koki Yamaoka MD, Susumu Ibe MD, Otoya Sekine MD, Yoshinori Katsumata MD, PhD, Takahiko Nishiyama MD, PhD, Takehiro Kimura MD, PhD, FHRS, Seiji Takatsuki MD, PhD, FHRS, Masaki Ieda MD, PhD","doi":"10.1016/j.hroo.2023.12.004","DOIUrl":"10.1016/j.hroo.2023.12.004","url":null,"abstract":"<div><h3>Background</h3><p>The complexity of leadless pacemaker (LP) implantation varies widely. However, the predictive factors determining this difficulty are poorly understood.</p></div><div><h3>Objective</h3><p>The purpose of this study was to evaluate the factors influencing LP implantation difficulty, specifically procedural time during right atrial (RA) and right ventricular (RV) manipulation, based on patient background, cardiac function, and anatomic characteristics.</p></div><div><h3>Methods</h3><p>Analysis included LP implantation cases between 2017 and 2023, excluding the initial 3 implants performed by each operator. The relevance of patient background, cardiac function, and anatomic features on procedural and fluoroscopy times was evaluated.</p></div><div><h3>Results</h3><p>Fifty-four patients (mean age 82.2 ± 10.0 years; 57.4% male) were included in the study. Median procedural and fluoroscopy time was 45.8 minutes and 16.0 minutes, respectively, with an average of 2.0 ± 1.4 device deployments. Univariate analysis showed associations between procedural time and older age, RA and RV diameter, and severity of tricuspid regurgitation (TR). After adjustment for physician and potential contributing factors, RV dilation (midventricular diameter ≥35 mm) and severe TR were identified as independent predictors of prolonged procedural time. Medical history exhibited no association with procedural time. Consistent results were observed in analyses using fluoroscopy time as the outcome.</p></div><div><h3>Conclusion</h3><p>RV dilation and severe TR were associated with prolonged procedural time for LP implantation. Anatomic features obtained from preprocedural echocardiography could provide valuable insights into both the safety and efficiency of LP implantation, thereby enhancing tailored treatment strategies for patients undergoing pacemaker implantation.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 97-102"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501823003343/pdfft?md5=c6e41691aff36599bac3f355451fa363&pid=1-s2.0-S2666501823003343-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139015509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2023.12.003
Andrea Papa MD, Teodor Serban MD, Ivo Strebel PhD, Sven Knecht DSc, PhD, Corinne Isenegger MMed, Thomas Nestelberger MD, Christoph Kaiser MD, Gregor Leibundgut MD, Philipp Haaf MD, Beat Schaer MD, Philipp Krisai MD, Stefan Osswald MD, Christian Sticherling MD, Michael Kühne MD, Patrick Badertscher MD
Background
Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood.
Objective
The purpose of this study was to assess the impact of valve implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR.
Methods
In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOTNCC, LVOTRCC, LVOTLCC, respectively).
Results
Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm3 [interquartile range 632–2400]. Delta HV showed no correlation with implantation depth or calcium burden (r = –0.08 and r = 0.12, respectively). However, LVOTNCC calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm3 increase (95% confidence interval 1.06–2.69; P = .04).
Conclusion
Assessment of LVOTNCC calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay.
{"title":"Impact of implantation depth and calcium burden on infranodal conduction delay after transcatheter aortic valve replacement","authors":"Andrea Papa MD, Teodor Serban MD, Ivo Strebel PhD, Sven Knecht DSc, PhD, Corinne Isenegger MMed, Thomas Nestelberger MD, Christoph Kaiser MD, Gregor Leibundgut MD, Philipp Haaf MD, Beat Schaer MD, Philipp Krisai MD, Stefan Osswald MD, Christian Sticherling MD, Michael Kühne MD, Patrick Badertscher MD","doi":"10.1016/j.hroo.2023.12.003","DOIUrl":"10.1016/j.hroo.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><p>Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood.</p></div><div><h3>Objective</h3><p>The purpose of this study was to assess the impact of valve implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR.</p></div><div><h3>Methods</h3><p>In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOT<sub>NCC</sub>, LVOT<sub>RCC</sub>, LVOT<sub>LCC</sub>, respectively).</p></div><div><h3>Results</h3><p>Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm<sup>3</sup> [interquartile range 632–2400]. Delta HV showed no correlation with implantation depth or calcium burden (r = –0.08 and r = 0.12, respectively). However, LVOT<sub>NCC</sub> calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm<sup>3</sup> increase (95% confidence interval 1.06–2.69; <em>P</em> = .04).</p></div><div><h3>Conclusion</h3><p>Assessment of LVOT<sub>NCC</sub> calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 113-121"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501823003331/pdfft?md5=e6605a3bc18bceee3c6128c0d47a4664&pid=1-s2.0-S2666501823003331-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139017485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2023.12.006
Bryan Wu MD , Todd Atwood PhD, DABR , Arno J. Mundt MD , Jennifer Karunamuni MD , Paul Stark MD , Albert Hsiao MD, PhD , Frederick Han MD , Jonathan C. Hsu MD MAS , Kurt Hoffmayer MD PharmD , Farshad Raissi MD , Ulrika Birgersdotter-Green MD , Gregory Feld MD , David E. Krummen MD , Gordon Ho MD
Background
Respiratory motion management strategies are used to minimize the effects of breathing on the precision of stereotactic ablative radiotherapy for ventricular tachycardia, but the extent of cardiac contractile motion of the human heart has not been systematically explored.
Objective
We aim to assess the magnitude of cardiac contractile motion between different directions and locations in the heart.
Methods
Patients with intracardiac leads or valves who underwent 4-dimensional cardiac computed tomography (CT) prior to a catheter ablation procedure for atrial or ventricular arrhythmias at 2 medical centers were studied retrospectively. The displacement of transvenous right atrial appendage, right ventricular (RV) implantable cardioverter-defibrillator, coronary sinus lead tips, and prosthetic cardiac devices across the cardiac cycle were measured in orthogonal 3-dimensional views on a maximal-intensity projection CT reconstruction.
Results
A total of 31 preablation cardiac 4-dimensional cardiac CT scans were analyzed. The LV lead tip had significantly greater motion compared with the RV lead in the anterior-posterior direction (6.0 ± 2.2 mm vs 3.8 ± 1.7 mm; P = .01) and superior-inferior direction (4.4 ± 2.9 mm vs 3.5 ± 2.0 mm; P = .049). The prosthetic aortic valves had the least movement of all fiducials, specifically compared with the RV lead tip in the left-right direction (3.2 ± 1.2 mm vs 6.1 ± 3.8 mm, P = .04) and the LV lead tip in the anterior-posterior direction (3.8 ± 1.7 mm vs 6.0 ± 2.2 mm, P = .03).
Conclusion
The degree of cardiac contractile motion varies significantly (1 mm to 15.2 mm) across different locations in the heart. The effect of contractile motion on the precision of radiotherapy should be assessed on a patient-specific basis.
背景呼吸运动管理策略用于最大限度地减少呼吸对室性心动过速立体定向消融放疗精确性的影响，但对人体心脏收缩运动的程度尚未进行系统的探讨。方法回顾性研究了在两家医疗中心接受导管消融术治疗房性或室性心律失常的心内导联或瓣膜患者，这些患者在接受导管消融术前都接受了四维心脏计算机断层扫描（CT）。在最大强度投影 CT 重建的正交三维视图中测量了经静脉右房阑尾、右心室 (RV) 植入式心律转复除颤器、冠状窦导联尖端和人工心脏装置在整个心动周期中的位移。在前后方向（6.0 ± 2.2 mm vs 3.8 ± 1.7 mm；P = .01）和上下方向（4.4 ± 2.9 mm vs 3.5 ± 2.0 mm；P = .049），左心室导联尖端的运动明显大于右心室导联。在所有靶标中，人工主动脉瓣的运动最小，特别是与左心室导联尖在左右方向（3.2 ± 1.2 mm vs 6.1 ± 3.8 mm，P = .04）和左心室导联尖在前后方向（3.8 ± 1.7 mm vs 6.0 ± 2.2 mm，P = .03）相比。应根据患者的具体情况评估收缩运动对放疗精确度的影响。
{"title":"Characterizing cardiac contractile motion for noninvasive radioablation of ventricular tachycardia","authors":"Bryan Wu MD , Todd Atwood PhD, DABR , Arno J. Mundt MD , Jennifer Karunamuni MD , Paul Stark MD , Albert Hsiao MD, PhD , Frederick Han MD , Jonathan C. Hsu MD MAS , Kurt Hoffmayer MD PharmD , Farshad Raissi MD , Ulrika Birgersdotter-Green MD , Gregory Feld MD , David E. Krummen MD , Gordon Ho MD","doi":"10.1016/j.hroo.2023.12.006","DOIUrl":"10.1016/j.hroo.2023.12.006","url":null,"abstract":"<div><h3>Background</h3><p>Respiratory motion management strategies are used to minimize the effects of breathing on the precision of stereotactic ablative radiotherapy for ventricular tachycardia, but the extent of cardiac contractile motion of the human heart has not been systematically explored.</p></div><div><h3>Objective</h3><p>We aim to assess the magnitude of cardiac contractile motion between different directions and locations in the heart.</p></div><div><h3>Methods</h3><p>Patients with intracardiac leads or valves who underwent 4-dimensional cardiac computed tomography (CT) prior to a catheter ablation procedure for atrial or ventricular arrhythmias at 2 medical centers were studied retrospectively. The displacement of transvenous right atrial appendage, right ventricular (RV) implantable cardioverter-defibrillator, coronary sinus lead tips, and prosthetic cardiac devices across the cardiac cycle were measured in orthogonal 3-dimensional views on a maximal-intensity projection CT reconstruction.</p></div><div><h3>Results</h3><p>A total of 31 preablation cardiac 4-dimensional cardiac CT scans were analyzed. The LV lead tip had significantly greater motion compared with the RV lead in the anterior-posterior direction (6.0 ± 2.2 mm vs 3.8 ± 1.7 mm; <em>P =</em> .01) and superior-inferior direction (4.4 ± 2.9 mm vs 3.5 ± 2.0 mm; <em>P =</em> .049). The prosthetic aortic valves had the least movement of all fiducials, specifically compared with the RV lead tip in the left-right direction (3.2 ± 1.2 mm vs 6.1 ± 3.8 mm, <em>P =</em> .04) and the LV lead tip in the anterior-posterior direction (3.8 ± 1.7 mm vs 6.0 ± 2.2 mm, <em>P =</em> .03).</p></div><div><h3>Conclusion</h3><p>The degree of cardiac contractile motion varies significantly (1 mm to 15.2 mm) across different locations in the heart. The effect of contractile motion on the precision of radiotherapy should be assessed on a patient-specific basis.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 131-136"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501823003367/pdfft?md5=2949eb2bc7066c6e2844bf7355d4008d&pid=1-s2.0-S2666501823003367-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2023.12.002
Mehrdad Golian MD , Nicolas M. Berbenetz MD , Roupen Odabashian MD , Mouhannad M. Sadek MD , Vicente Corrales-Medina MD , Alper Aydin MD , Darryl R. Davis MD , Martin S. Green MD , Andres Klein MD , Girish M. Nair MBBS, MSc , Pablo B. Nery MD , F. Daniel Ramirez MD , Calum Redpath MBChB, PhD , Simon P. Hansom MBBS , David H. Birnie MBChB, MD
Background
Cardiac implantable electronic device (CIED) infection is a costly and highly morbid complication. Perioperative interventions, including the use of antibiotic pouches and intensified perioperative antibiotic regimens, have demonstrated marginal efficacy at reducing CIED infection. Additional research is needed to identify additional interventions to reduce infection risk.
Objective
We sought to evaluate whether adherent skin barrier drape use is associated with a reduction in CIED infection.
Methods
A prospective registry of all CIED implantation procedures was established at our institution in January 2007. The registry was established in collaboration with our hospital infection prevention team with a specific focus on prospectively identifying all potential CIED infections. All potential CIED infections were independently adjudicated by 2 physicians blinded to the use of an adherent skin barrier drape.
Results
Over a 13-year period, 14,225 procedures were completed (mean age 72 ± 14 years; female 4,918 (35%); new implants 10,005 (70%); pulse generator changes 2585 (18%); upgrades 1635 (11%). Of those, 2469 procedures (17.4%) were performed using an adherent skin barrier drape. There were 103 adjudicated device infections (0.73%). The infection rate in patients in the barrier use groups was 8 of 2469 (0.32%) as compared with 95 of 11,756 (0.8%) in the nonuse group (P = .0084). In multivariable analysis, the use of an adherent skin barrier drape was independently associated with a reduction in infection (odds ratio 0.32; 95% confidence interval 0.154–0.665; P = .002).
Conclusion
The use of an adherent skin barrier drape at the time of cardiac device surgery is associated with a lower risk of subsequent infection.
{"title":"Adherent skin barrier drape use is associated with a reduced risk of cardiac implantable device infection: Results from a prospective study of 14,225 procedures","authors":"Mehrdad Golian MD , Nicolas M. Berbenetz MD , Roupen Odabashian MD , Mouhannad M. Sadek MD , Vicente Corrales-Medina MD , Alper Aydin MD , Darryl R. Davis MD , Martin S. Green MD , Andres Klein MD , Girish M. Nair MBBS, MSc , Pablo B. Nery MD , F. Daniel Ramirez MD , Calum Redpath MBChB, PhD , Simon P. Hansom MBBS , David H. Birnie MBChB, MD","doi":"10.1016/j.hroo.2023.12.002","DOIUrl":"10.1016/j.hroo.2023.12.002","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac implantable electronic device (CIED) infection is a costly and highly morbid complication. Perioperative interventions, including the use of antibiotic pouches and intensified perioperative antibiotic regimens, have demonstrated marginal efficacy at reducing CIED infection. Additional research is needed to identify additional interventions to reduce infection risk.</p></div><div><h3>Objective</h3><p>We sought to evaluate whether adherent skin barrier drape use is associated with a reduction in CIED infection.</p></div><div><h3>Methods</h3><p>A prospective registry of all CIED implantation procedures was established at our institution in January 2007. The registry was established in collaboration with our hospital infection prevention team with a specific focus on prospectively identifying all potential CIED infections. All potential CIED infections were independently adjudicated by 2 physicians blinded to the use of an adherent skin barrier drape.</p></div><div><h3>Results</h3><p>Over a 13-year period, 14,225 procedures were completed (mean age 72 ± 14 years; female 4,918 (35%); new implants 10,005 (70%); pulse generator changes 2585 (18%); upgrades 1635 (11%). Of those, 2469 procedures (17.4%) were performed using an adherent skin barrier drape. There were 103 adjudicated device infections (0.73%). The infection rate in patients in the barrier use groups was 8 of 2469 (0.32%) as compared with 95 of 11,756 (0.8%) in the nonuse group (<em>P</em> = .0084). In multivariable analysis, the use of an adherent skin barrier drape was independently associated with a reduction in infection (odds ratio 0.32; 95% confidence interval 0.154–0.665; <em>P</em> = .002).</p></div><div><h3>Conclusion</h3><p>The use of an adherent skin barrier drape at the time of cardiac device surgery is associated with a lower risk of subsequent infection.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 103-112"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266650182300332X/pdfft?md5=7ae2e56093fbccce9a00a935104edd69&pid=1-s2.0-S266650182300332X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2024.01.002
Hannah Schwennesen MD , Jeffrey N. Browndyke PhD , Mary Cooter Wright MS , Marat Fudim MD, MHS , James P. Daubert MD, FHRS , Mark F. Newman MD , Joseph P. Mathew MD, MHS, MBA , Jonathan P. Piccini MD, MHS, FHRS
Background
Cerebral microembolization and atrophy complicate atrial fibrillation (AF).
Objectives
We aimed to compare changes in neuroimaging findings between AF patients treated with catheter ablation and those treated with medical therapy.
Methods
In this pilot study, we evaluated differences in the change in regional white matter hyperintensity burden (WMHb) and cognitive function from baseline to 6 weeks and 1 year in patients treated with AF ablation (n = 12) and patients treated with medical management alone (n = 11). Change in cortical thickness over time in Alzheimer’s disease (AD) risk, aging-associated, and shared AD risk/aging regions was also compared between groups.
Results
The mean age was 69.7 ± 5.0 years, 78% of patients were male, 39% had persistent AF, and all received oral anticoagulation. There were no significant differences between groups in the change in cognitive function. At 6 weeks, there were no significant differences in periventricular WMHb changes between groups (0.00 vs 0.04, P = .12), but changes in attention/concentration were inversely correlated with periventricular (P = .01) and total (P = .03) WMHb. Medical management patients demonstrated significantly greater cortical thinning in AD risk regions from baseline to 1 year (P = .003).
Conclusions
AF patients who underwent ablation demonstrated less cortical thinning in regions associated with AD risk than patients treated with medical therapy. Larger, prospective studies are needed to better understand the relationship between AF therapies and the development of cognitive decline.
{"title":"A pilot study of longitudinal changes in neurocognition, white matter hyperintensities, and cortical thickness in atrial fibrillation patients following catheter ablation vs medical management","authors":"Hannah Schwennesen MD , Jeffrey N. Browndyke PhD , Mary Cooter Wright MS , Marat Fudim MD, MHS , James P. Daubert MD, FHRS , Mark F. Newman MD , Joseph P. Mathew MD, MHS, MBA , Jonathan P. Piccini MD, MHS, FHRS","doi":"10.1016/j.hroo.2024.01.002","DOIUrl":"10.1016/j.hroo.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Cerebral microembolization and atrophy complicate atrial fibrillation (AF).</p></div><div><h3>Objectives</h3><p>We aimed to compare changes in neuroimaging findings between AF patients treated with catheter ablation and those treated with medical therapy.</p></div><div><h3>Methods</h3><p>In this pilot study, we evaluated differences in the change in regional white matter hyperintensity burden (WMHb) and cognitive function from baseline to 6 weeks and 1 year in patients treated with AF ablation (n = 12) and patients treated with medical management alone (n = 11). Change in cortical thickness over time in Alzheimer’s disease (AD) risk, aging-associated, and shared AD risk/aging regions was also compared between groups.</p></div><div><h3>Results</h3><p>The mean age was 69.7 ± 5.0 years, 78% of patients were male, 39% had persistent AF, and all received oral anticoagulation. There were no significant differences between groups in the change in cognitive function. At 6 weeks, there were no significant differences in periventricular WMHb changes between groups (0.00 vs 0.04, <em>P =</em> .12), but changes in attention/concentration were inversely correlated with periventricular (<em>P =</em> .01) and total (<em>P =</em> .03) WMHb. Medical management patients demonstrated significantly greater cortical thinning in AD risk regions from baseline to 1 year (<em>P =</em> .003).</p></div><div><h3>Conclusions</h3><p>AF patients who underwent ablation demonstrated less cortical thinning in regions associated with AD risk than patients treated with medical therapy. Larger, prospective studies are needed to better understand the relationship between AF therapies and the development of cognitive decline.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 122-130"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000023/pdfft?md5=638b81a1abf749ab009bbdfe43b1335d&pid=1-s2.0-S2666501824000023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2024.01.001
Carlo de Asmundis MD, PhD , Lorenzo Marcon MD , Luigi Pannone MD , Domenico Giovanni Della Rocca MD, PhD , Dhanunjaya Lakkireddy MD , Thomas M. Beaver MD , Chad R. Brodt MD , Cinzia Monaco MD , Antonio Sorgente MD, PhD , Charles Audiat MD , Giampaolo Vetta MD , Robbert Ramak MSc , Ingrid Overeinder MD , Rani Kronenberger MD , Gezim Bala MD, PhD , Alexandre Almorad MD , Erwin Ströker MD, PhD , Juan Sieira MD, PhD , Andrea Sarkozy MD, PhD , Pedro Brugada MD, PhD , Mark La Meir MD, PhD
Background
Pericarditis is the most common complication following hybrid sinus node–sparing ablation for inappropriate sinus tachycardia (IST)/postural orthostatic tachycardia syndrome (POTS).
Objective
The study sought to evaluate the association of prophylaxis therapy on the risk of symptomatic pericarditis following hybrid IST/POTS ablation.
Methods
All consecutive patients undergoing to hybrid ablation of symptomatic IST/POTS refractory or intolerant to drugs were retrospectively analyzed. Pharmacological prophylaxis therapy was based on acetylsalicylic acid and colchicine started on the day of the ablation and continued for at least 3 months. The primary endpoint was occurrence of symptomatic pericarditis. The secondary endpoint was occurrence of pericarditis-related complications, including the following: duration of pericarditis >3 months, hospitalization for pericarditis, postpericardiectomy pleuro-pericarditis, and pericardiectomy.
Results
A total of 220 patients undergone to hybrid IST/POTS ablation were included and 44 (20%) underwent prophylaxis therapy. Pericarditis occurred in 101 (45.9%) patients, with 97 (96%) in the first 5 days. At survival analysis, prophylaxis was associated with higher rate of freedom from pericarditis (81.9% vs 47.2%, log-rank P < .001). Pericarditis-related complications were low, occurring in 7 (3.2%) patients. There was no difference in pericarditis-related complications between the patients who underwent prophylaxis therapy and patients who did not. At Cox multivariate analysis, predictors of pericarditis were IST (vs POTS) (hazard ratio 0.61, 95% confidence interval0.39-0.99, P = .04) and prophylaxis therapy (hazard ratio 0.27, 95% confidence interval 0.13-0.55, P < .001).
Conclusion
In a large cohort of patients undergoing hybrid ablation for IST/POTS, a prophylaxis therapy with acetylsalicylic acid and colchicine was associated with a lower rate of symptomatic pericarditis.
{"title":"Pericarditis prophylactic therapy after sinus node–sparing hybrid ablation for inappropriate sinus tachycardia/postural orthostatic sinus tachycardia","authors":"Carlo de Asmundis MD, PhD , Lorenzo Marcon MD , Luigi Pannone MD , Domenico Giovanni Della Rocca MD, PhD , Dhanunjaya Lakkireddy MD , Thomas M. Beaver MD , Chad R. Brodt MD , Cinzia Monaco MD , Antonio Sorgente MD, PhD , Charles Audiat MD , Giampaolo Vetta MD , Robbert Ramak MSc , Ingrid Overeinder MD , Rani Kronenberger MD , Gezim Bala MD, PhD , Alexandre Almorad MD , Erwin Ströker MD, PhD , Juan Sieira MD, PhD , Andrea Sarkozy MD, PhD , Pedro Brugada MD, PhD , Mark La Meir MD, PhD","doi":"10.1016/j.hroo.2024.01.001","DOIUrl":"10.1016/j.hroo.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Pericarditis is the most common complication following hybrid sinus node–sparing ablation for inappropriate sinus tachycardia (IST)/postural orthostatic tachycardia syndrome (POTS).</p></div><div><h3>Objective</h3><p>The study sought to evaluate the association of prophylaxis therapy on the risk of symptomatic pericarditis following hybrid IST/POTS ablation.</p></div><div><h3>Methods</h3><p>All consecutive patients undergoing to hybrid ablation of symptomatic IST/POTS refractory or intolerant to drugs were retrospectively analyzed. Pharmacological prophylaxis therapy was based on acetylsalicylic acid and colchicine started on the day of the ablation and continued for at least 3 months. The primary endpoint was occurrence of symptomatic pericarditis. The secondary endpoint was occurrence of pericarditis-related complications, including the following: duration of pericarditis >3 months, hospitalization for pericarditis, postpericardiectomy pleuro-pericarditis, and pericardiectomy.</p></div><div><h3>Results</h3><p>A total of 220 patients undergone to hybrid IST/POTS ablation were included and 44 (20%) underwent prophylaxis therapy. Pericarditis occurred in 101 (45.9%) patients, with 97 (96%) in the first 5 days. At survival analysis, prophylaxis was associated with higher rate of freedom from pericarditis (81.9% vs 47.2%, log-rank <em>P <</em> .001). Pericarditis-related complications were low, occurring in 7 (3.2%) patients. There was no difference in pericarditis-related complications between the patients who underwent prophylaxis therapy and patients who did not. At Cox multivariate analysis, predictors of pericarditis were IST (vs POTS) (hazard ratio 0.61, 95% confidence interval0.39-0.99, <em>P =</em> .04) and prophylaxis therapy (hazard ratio 0.27, 95% confidence interval 0.13-0.55, <em>P <</em> .001).</p></div><div><h3>Conclusion</h3><p>In a large cohort of patients undergoing hybrid ablation for IST/POTS, a prophylaxis therapy with acetylsalicylic acid and colchicine was associated with a lower rate of symptomatic pericarditis.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 137-144"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000011/pdfft?md5=9f46165f344d67d969191d2a71433634&pid=1-s2.0-S2666501824000011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139454731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.hroo.2023.12.007
Carlos Diaz-Arocutipa MD , Pablo M. Calderon-Ramirez MD , Frank Mayta-Tovalino PhD , Javier Torres-Valencia MD
Background
Leadless pacing has recently emerged as a promising therapy. The impact of frailty on the prognosis of these patients is currently unknown.
Objective
The purpose of this study was to assess the association between frailty and clinical outcomes in patients undergoing leadless pacemaker implantation.
Methods
We included adult patients who underwent leadless pacemaker implantation using the National Inpatient Sample from 2017 to 2019. Frailty was evaluated using the Hospital Frailty Risk Score and stratified into low, intermediate, and high risk. Primary outcomes were in-hospital mortality and any complication (vascular, pericardial, pneumothorax, infectious, or device related), and secondary outcomes were the length of hospital stay and total charges.
Results
A total of 16,825 patients were included in the final analysis, with 62% at intermediate or high risk of frailty. There was a higher risk of in-hospital mortality in patients at high (adjusted risk ratio [aRR] 6.37, 95% confidence interval [CI] 3.31–12.26) or intermediate (aRR 5.15, 95% CI 3.04–8.72) risk of frailty compared with those at low risk. Similarly, those at high or intermediate risk of frailty had higher total expenses and stayed in the hospital longer. Patients with a high (aRR 1.14, 95% CI 0.71–1.81) or intermediate (aRR 1.19, 95% CI 0.94–1.51) risk of frailty had a similar risk of any complication as patients with a low risk.
Conclusion
Frailty was common in patients undergoing leadless pacemaker implantation. Higher levels of frailty were a strong predictor of in-hospital mortality, length of hospital stay, and hospital charges, except for any complication.
{"title":"Association between frailty and in-hospital outcomes in patients undergoing leadless pacemaker implantation: A nationwide analysis","authors":"Carlos Diaz-Arocutipa MD , Pablo M. Calderon-Ramirez MD , Frank Mayta-Tovalino PhD , Javier Torres-Valencia MD","doi":"10.1016/j.hroo.2023.12.007","DOIUrl":"10.1016/j.hroo.2023.12.007","url":null,"abstract":"<div><h3>Background</h3><p>Leadless pacing has recently emerged as a promising therapy. The impact of frailty on the prognosis of these patients is currently unknown.</p></div><div><h3>Objective</h3><p>The purpose of this study was to assess the association between frailty and clinical outcomes in patients undergoing leadless pacemaker implantation.</p></div><div><h3>Methods</h3><p>We included adult patients who underwent leadless pacemaker implantation using the National Inpatient Sample from 2017 to 2019. Frailty was evaluated using the Hospital Frailty Risk Score and stratified into low, intermediate, and high risk. Primary outcomes were in-hospital mortality and any complication (vascular, pericardial, pneumothorax, infectious, or device related), and secondary outcomes were the length of hospital stay and total charges.</p></div><div><h3>Results</h3><p>A total of 16,825 patients were included in the final analysis, with 62% at intermediate or high risk of frailty. There was a higher risk of in-hospital mortality in patients at high (adjusted risk ratio [aRR] 6.37, 95% confidence interval [CI] 3.31–12.26) or intermediate (aRR 5.15, 95% CI 3.04–8.72) risk of frailty compared with those at low risk. Similarly, those at high or intermediate risk of frailty had higher total expenses and stayed in the hospital longer. Patients with a high (aRR 1.14, 95% CI 0.71–1.81) or intermediate (aRR 1.19, 95% CI 0.94–1.51) risk of frailty had a similar risk of any complication as patients with a low risk.</p></div><div><h3>Conclusion</h3><p>Frailty was common in patients undergoing leadless pacemaker implantation. Higher levels of frailty were a strong predictor of in-hospital mortality, length of hospital stay, and hospital charges, except for any complication.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 2","pages":"Pages 85-94"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501823003379/pdfft?md5=1ac8f43b3e9218f9e26d6b988a4e56ad&pid=1-s2.0-S2666501823003379-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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