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1.
Pacing Clin Electrophysiol ; 47(2): 336-341, 2024 02.
Article in English | MEDLINE | ID: mdl-38269497

ABSTRACT

BACKGROUND: Cardiac resynchronization therapy (CRT) is indicated for patients with heart failure with reduced left ventricular ejection fraction (LVEF) and chronic right ventricular (RV) pacing burden ≥40% (pacing-induced cardiomyopathy, PICM). It is uncertain whether baseline RV pacing burden impacts response to CRT. METHODS: We conducted a retrospective study of all CRT upgrades for PICM at our hospital from January 2017 to December 2018. Univariate and multivariable-adjusted changes in LVEF, and echocardiographic response (≥10% improvement in LVEF) at 3-12 months post-CRT upgrade were compared in those with RV pacing burden ≥90% versus <90%. RESULTS: We included 75 patients (age 74 ± 11 years, 71% male) who underwent CRT upgrade for PICM. The baseline RV pacing burden was ≥90% in 56 patients (median 99% [IQR 98%-99%]), and <90% in 19 patients (median 79% [IQR 73%-87%]). Improvement in LVEF was greater in those with baseline RV pacing burden ≥90% versus <90% (15.7 ± 9.3% vs. 7.5 ± 9.6%, p = .003). Baseline RV pacing burden ≥90% was a strong predictor of an improvement in LVEF ≥10% after CRT upgrade both in univariate and multivariate-adjusted models (p = .005 and .02, respectively). CONCLUSION: A higher baseline RV pacing burden predicts a greater improvement in LVEF after CRT upgrade for PICM.


Subject(s)
Cardiac Resynchronization Therapy , Cardiomyopathies , Heart Failure , Humans , Male , Middle Aged , Aged , Aged, 80 and over , Female , Stroke Volume/physiology , Ventricular Function, Left , Retrospective Studies , Treatment Outcome , Cardiomyopathies/therapy , Heart Failure/therapy , Cardiac Pacing, Artificial
2.
Pacing Clin Electrophysiol ; 44(10): 1793-1796, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34240780

ABSTRACT

Persistent left superior vena cava (PLSVC) poses technical challenges to implantation of transvenous cardiac implantable electronic devices. His-bundle pacing is a physiologic pacing strategy to avoid or treat pacing-induced cardiomyopathy. We report a case of His-bundle lead implantation in a patient with PLSVC, absent right SVC, and pacing-induced cardiomyopathy.


Subject(s)
Bundle of His/physiopathology , Cardiomyopathies/etiology , Pacemaker, Artificial , Persistent Left Superior Vena Cava/complications , Cardiomyopathies/physiopathology , Electrocardiography , Female , Humans , Middle Aged , Pacemaker, Artificial/adverse effects
3.
Pacing Clin Electrophysiol ; 41(7): 799-806, 2018 07.
Article in English | MEDLINE | ID: mdl-29659027

ABSTRACT

BACKGROUND: The safety of perioperative anticoagulation (AC) and antiplatelet (AP) therapy with subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is unknown. The purpose of this study was to identify the risk factors associated with hematoma complicating S-ICD implantation. METHODS: Records were retrospectively reviewed from 200 consecutive patients undergoing S-ICD implantation at two academic medical centers. A hematoma was defined as a device site blood accumulation requiring surgical evacuation, extended hospital stay, or transfusion. RESULTS: Among 200 patients undergoing S-ICD implantation (age 49 ± 17 years, 67% men), 10 patients (5%) had a hematoma, which required evacuation in six patients (3%). Warfarin was bridged or uninterrupted in 12 and 13 patients, respectively (6% and 6.5%). Four of 12 patients with warfarin and bridging AC (33%) and two of 13 patients with uninterrupted warfarin (15%) developed a hematoma. Neither of the two patients with uninterrupted DOAC had a hematoma. No patients on interrupted AC without bridging (n = 26, 13 with warfarin, 13 with DOAC) developed a hematoma. A hematoma was also more likely with the use of clopidogrel (n = 4/10 vs 10/190, 40% vs 5.3%, P < 0.0001) in combination with aspirin in 12/14 patients. Any bridging AC (odds ratio [OR] 10.3, 1.8-60.8, P = 0.01), clopidogrel (OR 10.0, 1.7-57.7, P = 0.01), and uninterrupted warfarin without bridging (OR 11.1, 1.7-74.3, P = 0.013) were independently associated with hematoma formation. CONCLUSION: AC and/or AP therapy with clopidogrel appears to increase the risk for hematoma following S-ICD implantation. Interruption of AC without bridging should be considered when it is an acceptable risk to hold AC.


Subject(s)
Anticoagulants/adverse effects , Aspirin/adverse effects , Clopidogrel/adverse effects , Defibrillators, Implantable , Hematoma/chemically induced , Hematoma/epidemiology , Platelet Aggregation Inhibitors/adverse effects , Postoperative Complications/chemically induced , Postoperative Complications/epidemiology , Warfarin/adverse effects , Female , Humans , Male , Middle Aged , Prosthesis Implantation/methods , Retrospective Studies , Risk Factors
4.
Am J Cardiol ; 116(6): 900-3, 2015 Sep 15.
Article in English | MEDLINE | ID: mdl-26174606

ABSTRACT

Atrioventricular node (AVN) ablation is an effective treatment for symptomatic patients with atrial arrhythmias who are refractory to rhythm and rate control strategies where optimal ventricular rate control is desired. There are limited data on the predictors of failure of AVN ablation. Our objective was to identify the predictors of failure of AVN ablation. This is an observational single-center study of consecutive patients who underwent AVN ablation in a large academic center. Baseline characteristics, procedural variables, and outcomes of AVN ablation were collected. AVN "ablation failure" was defined as resumption of AVN conduction resulting in recurrence of either rapid ventricular response or suboptimal biventricular pacing. A total of 247 patients drug refractory AF who underwent AVN ablation at our center with a mean age of 71 ± 12 years with 46% being males were included. Ablation failure was seen in 11 (4.5%) patients. There were no statistical differences between patients with "ablation failure" versus "ablation success" in any of the baseline clinical variables. Patients with moderate-to-severe tricuspid regurgitation (TR) were much more likely to have ablation failure than those with ablation success (8 [73%] vs 65 [27%]; p = 0.003). All 11 patients with ablation failure had a successful redo procedure, 9 with right and 2 with the left sided approach. On multivariate analysis, presence of moderate-to-severe TR was found to be the only predictor of failure of AVN ablation (odds ratio 9.1, confidence interval 1.99 to 42.22, p = 0.004). In conclusion, moderate-to-severe TR is a strong and independent predictor of failure of AVN ablation.


Subject(s)
Atrial Fibrillation/therapy , Atrioventricular Node/surgery , Cardiac Resynchronization Therapy , Catheter Ablation/methods , Tricuspid Valve Insufficiency/complications , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Combined Modality Therapy , Female , Heart Rate , Humans , Male , Middle Aged , Retrospective Studies , Treatment Failure , Treatment Outcome
5.
Int J Cardiol ; 191: 58-63, 2015 Jul 15.
Article in English | MEDLINE | ID: mdl-25965600

ABSTRACT

INTRODUCTION: Limited data is available regarding the novel Reveal LinQ (LinQ) which is a new generation implantable loop recorders (ILRs). METHODS: We performed a prospective, observational study of all consecutive patients undergoing conventional (Reveal XT; XT) and LinQ devices at our institution between January 2012 and December 2014. RESULTS: A total of 217 patients underwent ILR implantation. XT was implanted in 105 and LinQ in 112 patients. There were no significant differences in baseline characteristics between the two groups. LinQ implantation using the manufacturer's technique termed, "manufacturer's method" group had significantly higher incidence of pocket infection compared to XT (6/50, 12% vs 3/105, 3%, p=0.032). With modifications to the LinQ implantation technique (using a conventional scalpel and placing a suture when needed to the incision) termed "modified method" group, the rate of infection has decreased significantly compared to "manufacturer's method group" (0/62, 0% vs 6/50, 12%, p=0.004) (Table 3). In multivariate regression analysis, the only independent predictors of infection were younger age (OR 0.95; p=0.04), insertion of LinQ device (OR 30.02; p=0.006) and procedure time (OR 1.07; p=0.03). CONCLUSION: In our single-center, prospective, observational study we found that with the current implantable techniques, the novel insertable LinQ device is associated with increased risk of complications.


Subject(s)
Defibrillators, Implantable/adverse effects , Adult , Aged , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Defibrillators, Implantable/microbiology , Female , Humans , Infections/etiology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Risk Factors , Syncope/diagnosis , Syncope/etiology , Syncope/therapy , Tertiary Care Centers
6.
Pacing Clin Electrophysiol ; 31(2): 256-7, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18233984

ABSTRACT

We report an unusual case of a 75-year-old male electrocuted by lightning strike rescued by implantable cardioverter defibrillator (ICD) shock coincidentally. Lightning strikes are an unusual cause of fatal cardiac arrhythmias. Depending on the amount of energy and the current vector affecting the heart, the arrhythmia burden ranges from asystole to ventricular fibrillation.


Subject(s)
Defibrillators, Implantable , Lightning Injuries , Ventricular Fibrillation/etiology , Ventricular Fibrillation/therapy , Aged , Humans , Male
7.
Ann Noninvasive Electrocardiol ; 10(4): 429-35, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16255753

ABSTRACT

OBJECTIVES: We sought to evaluate the influence of single- versus dual-chamber implantable cardioverter defibrillators (ICDs) on the occurrence of heart failure and mortality as well as appropriate and inappropriate ICD therapy in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). BACKGROUND: In MADIT-II, ICD therapy in patients with a prior myocardial infarction and ejection fraction < or =0.30 was associated with a 31% reduction in risk of mortality when compared to conventionally treated patients. An unexpected finding was an increased occurrence of hospitalization for heart failure in the ICD group. METHODS: Data from 717 patients randomized to ICD therapy with single- or dual-chamber pacing devices in MADIT-II were retrospectively analyzed. Endpoints selected for analysis included death from any cause, new or worsening heart failure requiring hospitalization, death or heart failure, appropriate therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF), and inappropriate ICD therapy for atrial fibrillation or supraventricular tachycardia. RESULTS: A total of 404 single-chamber ICDs (S-ICDs) and 313 dual-chamber ICDs (D-ICDs) were implanted. Patients receiving D-ICDs were at a higher risk at baseline than those receiving S-ICDs, with older age, higher NYHA class, more frequent prior CABG, wider QRS complex, more LBBB, higher BUN level, a history of more atrial arrhythmias requiring treatment, and a longer time interval from their index myocardial infarction to enrollment. While there was a trend toward an increase in adverse outcomes in the D-ICD group, no statistically significant differences in heart failure or mortality were observed between S-ICD versus D-ICD groups. CONCLUSIONS: Patients with D-ICDs had a nonsignificant trend toward higher mortality and heart failure rates than patients with S-ICDs.


Subject(s)
Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/therapy , Defibrillators, Implantable/statistics & numerical data , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Risk Assessment/methods , Comorbidity , Defibrillators, Implantable/classification , Equipment Failure Analysis , Female , Humans , Male , Prognosis , Risk Factors , Survival Analysis , Survival Rate , Treatment Outcome , United States/epidemiology
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