Pub Date : 2024-03-01DOI: 10.1016/j.hroo.2024.02.001
Gurukripa N. Kowlgi MBBS, MS , Vaibhav Vaidya MBBS , Ming-Yan Dai MD , Pragyat Futela MBBS , Rahul Mishra MBBS , David O. Hodge , Abhishek J. Deshmukh MBBS , Siva K. Mulpuru MD, MPH , Paul A. Friedman MD , Yong-Mei Cha MD
Background
Cardiac implantable electronic devices (CIEDs), such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices, alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends.
Objectives
We sought to describe trends in noninfectious CIED complications over the past 3 decades in Olmsted County.
Methods
The Rochester Epidemiology Project is a medical records linkage system comprising records of over 500,000 residents of Olmsted County from 1966 to present. CIED implantations between 1988 and 2018 were determined. Trends in noninfectious complications within 30 days of implantation were analyzed.
Results
A total of 157 (6.2%) of 2536 patients who received CIED experienced device complications. A total of 2.7% of the implants had major complications requiring intervention. Lead dislodgement was the most common (2.8%), followed by hematoma (1.7%). Complications went up from 1988 to 2005, and then showed a downtrend until 2018, driven by a decline in hematomas in the last decade (P < .01). Those with complications were more likely to have prosthetic valves. Obesity appeared to have a protective effect in a multivariate regression model. The mean Charlson comorbidity index has trended up over the 30 years.
Conclusion
Our study describes a real-world trend of CIED complications over 3 decades. Lead dislodgements and hematomas were the most common complications. Complications have declined over the last decade due to safer practices and a better understanding of anticoagulant management.
{"title":"Trends in the 30-year span of noninfectious cardiovascular implantable electronic device complications in Olmsted County","authors":"Gurukripa N. Kowlgi MBBS, MS , Vaibhav Vaidya MBBS , Ming-Yan Dai MD , Pragyat Futela MBBS , Rahul Mishra MBBS , David O. Hodge , Abhishek J. Deshmukh MBBS , Siva K. Mulpuru MD, MPH , Paul A. Friedman MD , Yong-Mei Cha MD","doi":"10.1016/j.hroo.2024.02.001","DOIUrl":"10.1016/j.hroo.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac implantable electronic devices (CIEDs), such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices, alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends.</p></div><div><h3>Objectives</h3><p>We sought to describe trends in noninfectious CIED complications over the past 3 decades in Olmsted County.</p></div><div><h3>Methods</h3><p>The Rochester Epidemiology Project is a medical records linkage system comprising records of over 500,000 residents of Olmsted County from 1966 to present. CIED implantations between 1988 and 2018 were determined. Trends in noninfectious complications within 30 days of implantation were analyzed.</p></div><div><h3>Results</h3><p>A total of 157 (6.2%) of 2536 patients who received CIED experienced device complications. A total of 2.7% of the implants had major complications requiring intervention. Lead dislodgement was the most common (2.8%), followed by hematoma (1.7%). Complications went up from 1988 to 2005, and then showed a downtrend until 2018, driven by a decline in hematomas in the last decade (<em>P <</em> .01). Those with complications were more likely to have prosthetic valves. Obesity appeared to have a protective effect in a multivariate regression model. The mean Charlson comorbidity index has trended up over the 30 years.</p></div><div><h3>Conclusion</h3><p>Our study describes a real-world trend of CIED complications over 3 decades. Lead dislodgements and hematomas were the most common complications. Complications have declined over the last decade due to safer practices and a better understanding of anticoagulant management.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000278/pdfft?md5=e019c70923c849885f3a1c4dce6181f2&pid=1-s2.0-S2666501824000278-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139876661","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}
{"title":"Ultrasound-guided explantation technique for implantable loop recorder in patients with high body mass index: a practical approach","authors":"Chokanan Thaitirarot MBChB, MSc (oxon) , Shirley Sze MBBS, MD , Suzanne Armstrong MSc , Riyaz Somani MBChB, PhD","doi":"10.1016/j.hroo.2024.01.009","DOIUrl":"10.1016/j.hroo.2024.01.009","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000266/pdfft?md5=46e228934bfff3b27311f0ba672d5d37&pid=1-s2.0-S2666501824000266-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139883229","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 : 2024-03-01DOI: 10.1016/j.hroo.2024.01.008
Andrei Alexandru Mircea MD , Teodora Donisan MD , Steven Feigenberg MD , Michael G. Fradley MD
The incidence of cardiac implantable electronic device (CIED) malfunctions caused by radiotherapy (RT) is approximately 5%. Although individual national guidelines and expert consensus documents exist, the increased use of RT to treat various cancers points out the need for a standardized document to guide risk assessment and management of CIEDs during RT. We describe potential adverse RT-related events on CIEDs as well as the proposed mechanism of dysfunction. We review the main current guidelines and recommendations, emphasizing similarities and differences.
{"title":"What do national radiotherapy guidelines for patients with cardiac devices teach us?","authors":"Andrei Alexandru Mircea MD , Teodora Donisan MD , Steven Feigenberg MD , Michael G. Fradley MD","doi":"10.1016/j.hroo.2024.01.008","DOIUrl":"https://doi.org/10.1016/j.hroo.2024.01.008","url":null,"abstract":"<div><p>The incidence of cardiac implantable electronic device (CIED) malfunctions caused by radiotherapy (RT) is approximately 5%. Although individual national guidelines and expert consensus documents exist, the increased use of RT to treat various cancers points out the need for a standardized document to guide risk assessment and management of CIEDs during RT. We describe potential adverse RT-related events on CIEDs as well as the proposed mechanism of dysfunction. We review the main current guidelines and recommendations, emphasizing similarities and differences.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000254/pdfft?md5=590dbec29071b01214d5ef73cc5a4f89&pid=1-s2.0-S2666501824000254-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140162972","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 : 2024-03-01DOI: 10.1016/j.hroo.2024.01.006
Paul Coplan MBA, ScD , Amit Doshi MD, FHRS , Mingkai Peng PhD , Yariv Amos MSc , Mati Amit MSc , Don Yungher PhD , Rahul Khanna BPharm, MBA, PhD , Liat Tsoref PhD
Background
Local impedance drop in cardiac tissue during catheter ablation may be a valuable measure to guide atrial fibrillation (AF) ablation procedures for greater effectiveness.
Objective
The study sought to assess whether local impedance drop during catheter ablation to treat AF predicts 1-year AF recurrence and what threshold of impedance drop is most predictive.
Methods
We identified patients with AF undergoing catheter ablation in the Mercy healthcare system. We downloaded AF ablation procedural data recorded by the CARTO system from a cloud-based analytical tool (CARTONET) and linked them to individual patient electronic health records. Average impedance drops in anatomical region of right and left pulmonary veins were calculated. Effectiveness was measured by a composite outcome of repeat ablation, AF rehospitalization, direct current cardioversion, or initialization of a new antiarrhythmic drug post–blanking period. The association between impedance drop and 1-year AF recurrence was assessed by logistic regression adjusting for demographics, clinical, and ablation characteristics. Bootstrapping was used to determine the most predictive threshold for impedance drop based on the Youden index.
Results
Among 242 patients, 23.6% (n = 57) experienced 1-year AF recurrence. Patients in the lower third vs upper third of average impedance drop had a 5.9-fold (95% confidence interval [CI] 1.81–21.8) higher risk of recurrence (37.0% vs 12.5%). The threshold of 7.2 Ω (95% CI 5.75–7.7 Ω) impedance drop best predicted AF recurrence, with sensitivity of 0.73 and positive predictive value of 0.33. Patients with impedance drop ≤7.2 Ω had 3.5-fold (95% CI 1.39–9.50) higher risk of recurrence than patients with impedance drop >7.2 Ω, and there was no statistical difference in adverse events between the 2 groups of patients. Sensitivity analysis on right and left wide antral circumferential ablation impedance drop was consistent.
Conclusion
Average impedance drop is a strong predictor of clinical success in reducing AF recurrence but as a single criterion for predicting recurrence only reached 73% sensitivity and 33% positive predictive value.
{"title":"Predictive utility of the impedance drop on AF recurrence using digital intraprocedural data linked to electronic health record data","authors":"Paul Coplan MBA, ScD , Amit Doshi MD, FHRS , Mingkai Peng PhD , Yariv Amos MSc , Mati Amit MSc , Don Yungher PhD , Rahul Khanna BPharm, MBA, PhD , Liat Tsoref PhD","doi":"10.1016/j.hroo.2024.01.006","DOIUrl":"10.1016/j.hroo.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Local impedance drop in cardiac tissue during catheter ablation may be a valuable measure to guide atrial fibrillation (AF) ablation procedures for greater effectiveness.</p></div><div><h3>Objective</h3><p>The study sought to assess whether local impedance drop during catheter ablation to treat AF predicts 1-year AF recurrence and what threshold of impedance drop is most predictive.</p></div><div><h3>Methods</h3><p>We identified patients with AF undergoing catheter ablation in the Mercy healthcare system. We downloaded AF ablation procedural data recorded by the CARTO system from a cloud-based analytical tool (CARTONET) and linked them to individual patient electronic health records. Average impedance drops in anatomical region of right and left pulmonary veins were calculated. Effectiveness was measured by a composite outcome of repeat ablation, AF rehospitalization, direct current cardioversion, or initialization of a new antiarrhythmic drug post–blanking period. The association between impedance drop and 1-year AF recurrence was assessed by logistic regression adjusting for demographics, clinical, and ablation characteristics. Bootstrapping was used to determine the most predictive threshold for impedance drop based on the Youden index.</p></div><div><h3>Results</h3><p>Among 242 patients, 23.6% (n = 57) experienced 1-year AF recurrence. Patients in the lower third vs upper third of average impedance drop had a 5.9-fold (95% confidence interval [CI] 1.81–21.8) higher risk of recurrence (37.0% vs 12.5%). The threshold of 7.2 Ω (95% CI 5.75–7.7 Ω) impedance drop best predicted AF recurrence, with sensitivity of 0.73 and positive predictive value of 0.33. Patients with impedance drop ≤7.2 Ω had 3.5-fold (95% CI 1.39–9.50) higher risk of recurrence than patients with impedance drop >7.2 Ω, and there was no statistical difference in adverse events between the 2 groups of patients. Sensitivity analysis on right and left wide antral circumferential ablation impedance drop was consistent.</p></div><div><h3>Conclusion</h3><p>Average impedance drop is a strong predictor of clinical success in reducing AF recurrence but as a single criterion for predicting recurrence only reached 73% sensitivity and 33% positive predictive value.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000072/pdfft?md5=797b9358bed2f75ad0de9686b9081c93&pid=1-s2.0-S2666501824000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139684902","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 : 2024-03-01DOI: 10.1016/j.hroo.2024.01.007
Ehud Chorin MD, PhD , Rachel Lampert MD , Nick R. Bijsterveld MD, PhD , Reinoud E. Knops MD, PhD , Arthur A.M. Wilde MD , Hein Heidbuchel MD, PhD, FEHRA, FESC , Andrew Krahn MD , Ilan Goldenberg MD , Raphael Rosso MD , Dana Viskin MD , Shir Frydman MD , Lior Lupu MD , Sami Viskin MD
Background
Recent studies suggest that participation in recreational and even competitive sports is generally safe for patients with implantable cardioverter-defibrillators (ICDs). However, these studies included only patients with implanted transvenous ICD (TV-ICD). Nowadays, subcutaneous ICD (S-ICD) is a safe and effective alternative and is increasingly implanted in younger ICD candidates. Data on the safety of sport participation for patients with implanted S-ICD systems is urgently needed.
Objectives
The goal of the study is to quantify the risks (or determine the safety) of sports participation for athletes with an S-ICD, which will guide shared decision making for athletes requiring an ICD and/or wishing to return to sports after implantation.
Methods
The SPORT S-ICD (Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator) study is an international, multicenter, prospective, noninterventional, observational study, designed specifically to collect data on the safety of sports participation among patients with implanted S-ICD systems who regularly engage in sports activities.
Results
A total of 450 patients will undergo baseline assessment including baseline characteristics, indication for S-ICD implantation, arrhythmic history, S-ICD data and programming, and data regarding sports activities. LATITUDE Home Monitoring information will be regularly transferred to the study coordinator for analysis.
Conclusion
The results of the study will aid in shaping clinical decision making, and if the tested hypothesis will be proven, it will allow the safe continuation of sports for patients with an implanted S-ICD
{"title":"Safety of Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator (SPORT S-ICD): study rationale and protocol","authors":"Ehud Chorin MD, PhD , Rachel Lampert MD , Nick R. Bijsterveld MD, PhD , Reinoud E. Knops MD, PhD , Arthur A.M. Wilde MD , Hein Heidbuchel MD, PhD, FEHRA, FESC , Andrew Krahn MD , Ilan Goldenberg MD , Raphael Rosso MD , Dana Viskin MD , Shir Frydman MD , Lior Lupu MD , Sami Viskin MD","doi":"10.1016/j.hroo.2024.01.007","DOIUrl":"10.1016/j.hroo.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies suggest that participation in recreational and even competitive sports is generally safe for patients with implantable cardioverter-defibrillators (ICDs). However, these studies included only patients with implanted transvenous ICD (TV-ICD). Nowadays, subcutaneous ICD (S-ICD) is a safe and effective alternative and is increasingly implanted in younger ICD candidates. Data on the safety of sport participation for patients with implanted S-ICD systems is urgently needed.</p></div><div><h3>Objectives</h3><p>The goal of the study is to quantify the risks (or determine the safety) of sports participation for athletes with an S-ICD, which will guide shared decision making for athletes requiring an ICD and/or wishing to return to sports after implantation.</p></div><div><h3>Methods</h3><p>The SPORT S-ICD (Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator) study is an international, multicenter, prospective, noninterventional, observational study, designed specifically to collect data on the safety of sports participation among patients with implanted S-ICD systems who regularly engage in sports activities.</p></div><div><h3>Results</h3><p>A total of 450 patients will undergo baseline assessment including baseline characteristics, indication for S-ICD implantation, arrhythmic history, S-ICD data and programming, and data regarding sports activities. LATITUDE Home Monitoring information will be regularly transferred to the study coordinator for analysis.</p></div><div><h3>Conclusion</h3><p>The results of the study will aid in shaping clinical decision making, and if the tested hypothesis will be proven, it will allow the safe continuation of sports for patients with an implanted S-ICD</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000242/pdfft?md5=2c2117f45c36a39f4eeabc3a9f783f88&pid=1-s2.0-S2666501824000242-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139891022","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 : 2024-03-01DOI: 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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}